Online correlation of spontaneous arterial and intracranial pressure fluctuations in patients with diffuse severe head injury.
Determination of relevant clinical monitoring parameters for helping guide the intensive care therapy in patients with severe head injury, is one of the most demanding issues in neurotrauma research. New insights into cerebral autoregulation and metabolism have revealed that a rigid cerebral perfusion pressure (CPP) regimen might not be suitable for all severe head injured patients. We thus developed an online analysis technique to monitor the correlation (AI rho) between the spontaneous fluctuations of the mean arterial blood pressure (MABP) and the intracranial pressure (ICP). In addition, brain tissue oxygen (PtiO2) and metabolic microdialysate measures including glucose and lactate were registered. We found that in patients with good outcome, the AI rho values were significantly lower as compared with patients with poor outcome. Accordingly, microdialysate glucose and lactate were significantly higher in the good outcome group. We conclude that online determination of AI rho offers a valuable additional and technically easily performable tool for guidance of therapy in patients with severe head injury.
Reinert
Michael
M
Department of Neurosurgery, Inselspital Bern, University of Bern, 3010 Bern, Switzerland. michael.reinert@neurochirurgie-bern.ch
Andres
Robert H
RH
Fuhrer
Martin
M
Müller
Alexander
A
Schaller
Benoit
B
Widmer
HansRuedi
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D001930:Brain Injuries / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D017551:Microdialysis / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009862:Online Systems; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015898:Tomography Scanners, X-Ray Computed