Artikel
Passive Leg Raising in Neurosurgical Intensive Care Patients. A prospective Trial
Suche in Medline nach
Autoren
-
Marlies Bauer
- Neurochirurgie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Austria
-
Christian Freyschlag
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria
-
Daniel Basic
- Kardiologie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Austria
-
Marina Popovscaia
- Biostatistik Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Austria
-
Elke Münch
- Gesundheitszentrum Weinheim, Weinheim, Deutschland
-
Ludwig Schürer
- Klinik für Neurochirurgie, Städt. Klinikum Bogenhausen, München, Deutschland
-
Claudius Thomé
- A.ö. Landeskrankenhaus - Universitätskliniken Innsbruck, Tirol Kliniken GmbH, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
| Veröffentlicht: | 9. Juni 2017 |
|---|
Gliederung
Text
Objective: Individual volume management in critically ill patients is crucial to avoid adverse events and improve outcome. Hyper- as well as hypovolemia are known to worsen the prognosis of critically ill patients. Therefore, a goal-directed therapy (GDT) to reach normal and supranormal values of cardiac output and oxygen delivery (DO2) is beneficial to prevent perioperative complications and organ failure. GDT and continuous ScvO2 (PiCCO) monitoring showed a significant increase in postoperative outcome in elective surgery. To stabilize hemodynamics and optimize cardiac preload, individual fluid responsiveness should be assessed. Passive leg raising (PLR)-induced changes in cardiac output reliably predict fluid responsiveness in the majority of non-neurological ICU population. To date, no study has evaluated the use of the passive leg raising-test in patients with intracranial pathology due to a potential risk of increase in intracranial pressure (ICP). The purpose of this study was to test the clinical feasibility and utility of PLR in the neurosurgical intensive care unit (NICU).
Methods: Between January 2016 and September 2016 10 patients with subarachnoid hemorrhage (SAH) or severe TBI were enrolled. Data was collected prospectively, after approval by the university ethics committee. Acquisition of echocardiography prior to testing to evaluate patients ejection fraction to avoid cardiac adverse events during PLR was done. PLR-test was accomplished within 48 hours (acute phase) after TBI/SAH, a second test within day 5-8 postoperatively (subacute phase), provided an initial ICP < 20 mmHg. All patients had an intraparenchymal ICP and Licox probe. Statistical analysis was performed using SPSS statistics. A probability P value of less than 0.05 was considered significant.
Results: TBI patients (n=6) were all male, whereas all SAH patients (n=4) were female. Mean patient age was 55.6 years (range 35-76). All but two patients were able to undergo testing twice. One patient was transferred to another hospital, the other one died unrelated to the study. Overall, 18 PLR-tests could be performed. One maneuver had to be terminated due to increase of ICP over 25 mmHg. The ICP elevation was self-limiting. In 17 tests, no hazardous increase of ICP was found neither in the first 48 hours (mean 8.45 mmHg, range 4-16), nor in the subacute phase (mean 9.12 mmHg, range 3-18). PtbO2 was measured continuously while testing and was collected the following 10 minutes, which revealed a mean increase of 1.22 mmHg.
Conclusion: We could demonstrate no significant increase in ICP during the acute phase, as well during the subacute phase. Additionally, these data show a tendency towards an increase of PtbO2 after PLR. The results of this small prospective study demonstrate the feasibility and utility of PLR in neurosurgical intensive care unit patients and provides a basis for further studies.
