Continuous regional cerebral blood flow monitoring in the neurosurgical intensive care unit.
The aim of this study was to examine the intracranial pressure (ICP) and regional cerebral blood flow (rCoBF) changes during the acute stage of severe head injury and to improve outcome by modifying treatment modalities using real-time ICP and rCoBF data. Twenty patients with moderate or severe head injury that were monitored in our neurosurgical intensive care unit were included in this study. The changes in ICP, rCoBF and the relationship of ICP/rCoBF were observed. In patients with high ICP and low rCoBF, mannitol improves the rCoBF and decreases the ICP of these patients. When low rCoBF exists, hyperventilation may lead to a rapid further decline of rCoBF, however, some hyperemic brains respond well to hyperventilation treatment. Triple-H therapy is suitable for those with low rCoBF without significantly high ICP, which is an abnormal condition considered to be caused by vasospasm.
Lee
Sai-Cheung
SC
Department of Neurosurgery, Chang Gung University & Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Chen
Jyi-Feng
JF
Lee
Shih-Tseng
ST
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000098:blood supply / Q000502:physiology / Q000503:physiopathology; D001929:Brain Edema / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D020520:Brain Infarction / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D002536:Cerebral Arteries / Q000502:physiology / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003422:Critical Care / Q000379:methods* / Q000592:standards / Q000639:trends; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards / Q000639:trends; D009493:Neurosurgery / Q000379:methods* / Q000592:standards / Q000639:trends; D011182:Postoperative Care / Q000379:methods* / Q000592:standards / Q000639:trends; D012212:Rheology / Q000295:instrumentation / Q000379:methods; D014159:Transducers / Q000592:standards / Q000639:trends; D020301:Vasospasm, Intracranial / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy
D004234:Diuretics, Osmotic; D008353:Mannitol