Evaluate the relationship between the brain tissue oxygen pressure with intracranial pressure and cerebral perfusion pressure in patients with severe traumatic brain injury

2017 ◽  
Vol 381 ◽  
pp. 754
Author(s):  
V. Hoang Phuong ◽  
N. Quoc Kinh
Keyword(s):  
Traumatic Brain Injury ◽  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Tissue Oxygen ◽  
Brain Tissue Oxygen ◽  
Brain Tissue Oxygen Pressure ◽  
The Relationship ◽  
The Brain ◽  
Tissue Oxygen Pressure

Incidence and characteristics of cerebral hypoxia after craniectomy in brain-injured patients: a cohort study

2020 ◽  
pp. 1-8
Author(s):  
Alexandrine Gagnon ◽  
Mathieu Laroche ◽  
David Williamson ◽  
Marc Giroux ◽  
Jean-François Giguère ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Cerebral Hypoxia ◽  
Tissue Oxygen ◽  
Brain Hypoxia ◽  
Brain Tissue Oxygen ◽  
Common Causes ◽  
Brain Tissue Oxygen Pressure ◽  
Tissue Oxygen Pressure

OBJECTIVEAfter craniectomy, although intracranial pressure (ICP) is controlled, episodes of brain hypoxia might still occur. Cerebral hypoxia is an indicator of poor outcome independently of ICP and cerebral perfusion pressure. No study has systematically evaluated the incidence and characteristics of brain hypoxia after craniectomy. The authors’ objective was to describe the incidence and characteristics of brain hypoxia after craniectomy.METHODSThe authors included 25 consecutive patients who underwent a craniectomy after traumatic brain injury or intracerebral hemorrhage and who were monitored afterward with a brain tissue oxygen pressure monitor.RESULTSThe frequency of hypoxic values after surgery was 14.6% despite ICP being controlled. Patients had a mean of 18 ± 23 hypoxic episodes. Endotracheal (ET) secretions (17.4%), low cerebral perfusion pressure (10.3%), and mobilizing the patient (8.6%) were the most common causes identified. Elevated ICP was rarely identified as the cause of hypoxia (4%). No cause of cerebral hypoxia could be determined 31.2% of the time. Effective treatments that were mainly used included sedation/analgesia (20.8%), ET secretion suctioning (15.4%), and increase in fraction of inspired oxygen or positive end-expiratory pressure (14.1%).CONCLUSIONSCerebral hypoxia is common after craniectomy, despite ICP being controlled. ET secretion and patient mobilization are common causes that are easily treatable and often not identified by standard monitoring. These results suggest that monitoring should be pursued even if ICP is controlled. The authors’ findings might provide a hypothesis to explain the poor functional outcome in the recent randomized controlled trials on craniectomy after traumatic brain injury where in which brain tissue oxygen pressure was not measured.

HYPERTONIC SALINE AND ITS EFFECT ON INTRACRANIAL PRESSURE, CEREBRAL PERFUSION PRESSURE, AND BRAIN TISSUE OXYGEN

Neurosurgery ◽  
2009 ◽  
Vol 65 (6) ◽  
pp. 1035-1042 ◽  
Author(s):  
Gaylan L. Rockswold ◽  
Craig A. Solid ◽  
Eduardo Paredes-Andrade ◽  
Sarah B. Rockswold ◽  
Jon T. Jancik ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Brain Tissue ◽  
Cerebral Perfusion Pressure ◽  
Hypertonic Saline ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Tissue Oxygen ◽  
Brain Tissue Oxygen

scholarly journals Acute clinical grading in pediatric severe traumatic brain injury and its association with subsequent intracranial pressure, cerebral perfusion pressure, and brain oxygenation

2008 ◽  
Vol 25 (4) ◽  
pp. E4 ◽  
Author(s):  
Anthony A. Figaji ◽  
Eugene Zwane ◽  
A. Graham Fieggen ◽  
Jonathan C. Peter ◽  
Peter D. Leroux
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Severe Traumatic Brain Injury ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Brain Oxygenation ◽  
Clinical Scores ◽  
The Relationship

Object The goal of this paper was to examine the relationship between methods of acute clinical assessment and measures of secondary cerebral insults in severe traumatic brain injury in children. Methods Patients who underwent intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain oxygenation (PbtO2) monitoring and who had an initial Glasgow Coma Scale score, Pediatric Trauma Score, Pediatric Index of Mortality 2 score, and CT classification were evaluated. The relationship between these acute clinical scores and secondary cerebral insult measures, including ICP, CPP, PbtO2, and systemic hypoxia were evaluated using univariate and multivariate analysis. Results The authors found significant associations between individual acute clinical scores and select physiological markers of secondary injury. However, there was a large amount of variability in these results, and none of the scores evaluated predicted each and every insult. Furthermore, a number of physiological measures were not predicted by any of the scores. Conclusions Although they may guide initial treatment, grading systems used to classify initial injury severity appear to have a limited value in predicting who is at risk for secondary cerebral insults.

Attenuation of Haemodynamic Response to Placement of Mayfield Skull Pin Head Holder - Comparison of Dexmedetomidine Versus Propofol Infusion - A Randomized Interventional Trial Done in a Tertiary Centre in Central Kerala

2021 ◽  
Vol 8 (29) ◽  
pp. 2639-2643
Author(s):  
Sruthy Unni ◽  
Ranju Sebastian ◽  
Elizabeth Joseph ◽  
Remani Kelan Kamalakshi ◽  
Jamsheena Muthira Parambath
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Stress Response ◽  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Neurosurgical Procedures ◽  
Sympathetic Nervous ◽  
The Brain ◽  
Group 1

BACKGROUND Anaesthesia for neurosurgery requires special considerations. The brain is enclosed in a rigid cranium, so the rise in intracranial pressure (ICP) which impairs cerebral perfusion pressure (CPP), results in irrepairable damage to various vital areas in the brain. Stable head position is required in long neurosurgical procedures. This is obtained with the use of clamps which fix the head rigidly. This is done usually under general anaesthesia because it produces intense painful stimuli leading to stimulation of sympathetic nervous system which in turn causes release of vasoconstrictive agents. This can impair perfusion in all organ systems. The increase in blood pressure due to sympathetic nervous system causes increase in blood flow. This causes increases in intracranial pressure which result in reduction in cerebral perfusion pressure once the auto regulatory limits are exceeded. We compared the effects of dexmedetomidine 1 µgm/kg and propofol 100 µgm/kg given as infusion over a period of 10 minutes before the induction of anaesthesia and continued till 5 minutes after pinning to attenuate the stress response while cranial pinning. In this study, we wanted to compare the effects of dexmedetomidine and propofol as infusion to attenuate the stress response while cranial pinning in patients undergoing neurosurgical procedures. METHODS This is a randomized interventional trial. Patients were divided into 2 groups of 20 each. Group 1 receiving dexmedetomidine and group 2 receiving propofol, both drugs given as infusion. Haemodynamic variables were monitored before and after cranial pinning. Data was analysed using IBM statistical package for social sciences (SPSS) statistics. The parameters recorded were analysed with the help of a statistician. RESULTS The two groups were comparable in demographic data. Incidence of tachycardia between group 1 and 2 showed that tachycardia to pinning was better controlled with propofol than dexmedetomidine (P < 0.05) which is statistically significant. There is no statistically significant difference in blood pressure values between group 1 and 2 after pinning. CONCLUSIONS From our study, we came to a conclusion that propofol was superior to dexmedetomidine in attenuating the heart rate response to cranial pinning. The effect of propofol and dexmedetomidine was comparable in attenuating the blood pressure response to cranial pinning. KEYWORDS Cranial Pinning, Dexmedetomidine, Propofol

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