Intensive Care for Patients with Subarachnoid Haemorrhage

2002 ◽  
Vol 15 (5) ◽  
pp. 619-623
Author(s):  
M. Berardino ◽  
P.F. Sciacca
Keyword(s):  
Intensive Care ◽  
Subarachnoid Haemorrhage ◽  
Central Venous Pressure ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Intensive Care Treatment ◽  
Central Venous ◽  
Cerebral Monitoring

The intensive care treatment in patients with subarachnoid haemorrhage (SAH) is aimed at maintenance of adequate cerebral perfusion and oxygenation. SAH is charged in 40% of cases with at least one life-threatening event and 20 to 30% of deaths are related to extracerebral complications. So the main task in Neurointensive Care is to keep the physiological parameters under control. That is why we need accurate monitoring. Currently used systemic and cerebral monitoring is thus presented. Even basic cardiovascular monitoring (ECG, blood pressure, pulse oxymetry, central venous pressure, urine output) need a great workload in managing the quality of signals and raw data. SAH is often associated with cardiovascular impairment; haemodynamic monitoring is then necessary to graduate hynotropic (stroke volume, cardiac index, systemic and pulmonary resistances) and volemic support (central venous pressure, wedge pressure): a Swan-Ganz catheter is then indicated. Then ventilation is considered: non only a “cerebral” oriented ventilation but a strategy aimed at pulmonary protection too. The ultimate result of ventilation is still adequate oxygenation and acid-base balance that are to be verified. Cerebral monitoring is then resumed starting from cerebral perfusion pressure. The O2 delivery is monitored by a global estimation like jugular venous oxygen saturation, that has a low sensitivity in SAH patients, and by tissue O2 tension which measure O2 delivered near the injured area. Lastly, Transcranial Doppler Monitoring is presented with its limits and indications. Three clinical examples are presented on a multimodal approach in TCD, PtO2 and cerebral perfusion pressure monitoring.

Divergence of Intracranial and Central Venous Pressures in Lightly Anesthetized, Tracheally Intubated Dogs That Move in Response to a Noxious Stimulus

1996 ◽  
Vol 84 (3) ◽  
pp. 605-613 ◽  
Author(s):  
William L. Lanier ◽  
Ronald F. Albrecht ◽  
Paul A. Iaizzo
Keyword(s):  
Central Venous Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Superior Vena ◽  
Venous Pressure ◽  
Intrathoracic Pressure ◽  
Noxious Stimulus ◽  
Central Venous ◽  
Superior Vena Caval ◽  
The Right

Background Intracranial pressure (ICP) may increase in tracheally intubated subjects during periods of movement (e.g, "bucking" and coughing). Recent research has suggested that factors other than passive congestion of the cerebral vessels, resulting from increases in central venous pressure, may contribute to the ICP response. The current study evaluated this issue in a canine model of intracranial hypertension and additionally evaluated the relationship between ICP and static increases in superior vena caval pressure. Methods Six dogs were lightly anesthetized with 0.65% end-expired halothane in oxygen and nitrogen, and ventilation was mechanically controlled. Intracranial pressure was increased to a stable baseline of 15-20 mmHg using a subarachnoid infusion of warm 0.9% saline solution. The following variables were quantified before, and for 6 min after, initiating a 1-min noxious stimulus to the trachea and skin: ICP, central venous pressure, electromyograms (masseter, deltoid, and intercostal muscles), intrathoracic pressure, and cerebral perfusion pressure (defined as mean arterial pressure -- ICP). Later, the protocol was repeated in the presence of neuromuscular block with pancuronium. Finally, in the same dogs, occlusion of the superior vena cava at its junction with the right atrium was used to increase superior vena caval pressure in 5-mmHg increments, from 5 to 30 mmHG, so that the resulting increases in ICP could be quantified. Results In unparalyzed dogs whose heads were maintained at the level of the right atrium, there was a 22-mmHg increase in ICP at 1 min after initiating the noxious stimulus (P<0.05). The ICP increase was related to electromyogram activation and a 6-mmHg increase in central venous pressure; however, it was not associated with significant increases in intrathoracic pressure or cerebral perfusion pressure. Treatment with pancuronium abolished the electromyographic, ICP, and central venous pressure responses to noxious stimulus. When superior vena caval pressure was statically manipulated, the resulting ICP increase was only one half the magnitude of the superior vena caval pressure increase. After elevating the head 14 cm, the ratio of ICP to superior vena pressure increases was reduced to one third. Conclusions If these results apply to humans, it was concluded that increases in ICP that accompany movement in tracheally intubated patients may arise from two complementary factors: (1) cerebrovascular dilation that correlates with electromyographic activity and is mediated by ascending neural pathways that transmit proprioreceptive information, and (2) passive venous congestion that results from any increase in central venous pressure. The influence of the latter factor can be reduced by elevating the head. (Key words: Blood pressure, venous pressure; mean arterial pressure. Muscle: afferent activity; electromyograms, skeletal. Neuromuscular relaxants: pancuronium.)

Evaluación del conocimiento del enfermero sobre la importancia del monitoreo de la presión venosa central en pacientes críticos

2011 ◽  
Vol 5 (9) ◽  
pp. 2091
Author(s):  
Rayssa Nogueira Duarte ◽  
Sarah Maria de Sousa Feitoza ◽  
Elizabeth Mesquita Melo ◽  
Islene Victor Barbosa ◽  
Rita Mônica Borges Studart ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Pressure ◽  
Normal Values ◽  
Venous Pressure ◽  
Venous Catheter ◽  
Central Venous ◽  
X Ray ◽  
Hemodynamic Impairment ◽  
Terapia Intensiva ◽  
Definition Of

RESUMENObjective: identificar el conocimiento del enfermero sobre el monitoreo de la presión venosa central (PVC) en columna de agua en pacientes críticos. Método: estudio exploratorio descriptivo, cuantitativo, realizado en dos unidades de cuidados intensivos con 24 enfermeros. Datos recolectados de enero a abril de 2010, por medio de un cuestionario, agrupados en frecuencias absolutas y relativas, y expuestos en figuras y tablas. El proyecto fue encaminado al Comité de Ética en Investigación del Hospital São José, aprobado con el protocolo 055/2009, CAAE 0056.0.042.000-9. Resultados: mayoría de sexo femenino, con media de edad de 38,2 y 13,4 años de formación; 45,8% conocían la definición de PVC y 54,16 relataron correctamente sus valores normales. Aunque 62,5% no citó dificultades con la PVC, se observaron dudas sobre posición del catéter venoso central, chequeo por rayo-x, e identificación del eje flebostático del paciente. Conclusiones: se identificó falta de conocimiento sobre la importancia y objetivos de la PVC para seguimiento de la hemodinámica del paciente grave, siendo esencial una educación en servicio sobre la temática. Descriptores: atención de enfermería; presión venosa central; unidad de cuidados intensivos.ABSTRACTObjective: to evaluate the knowledge of nurse about of the monitoring the central venous pressure (CVP) in the water column in critically ill patients. Method: exploratory quantitative study, conducted in two intensive care units with 24 nurses. Data were collected from January to April 2010, after the Research Ethics Committee of the Hospital São José approved the project (Protocol protocolo 055/2009, CAAE 0056.0.042.000-9), with a questionnaire, grouped in absolute and relative frequencies and displayed in figures and tables. Results: the sample were mainly female, mean age of 38.2 and 13.4 years after graduation, 45.8% knew the definition of PVC and 54.16% correctly reported their normal values. While 62.5% have not mentioned difficulties related to PVC, there was doubt about the position of central venous catheter by x-ray check and identification phlebostatic axis of the patient. Conclusion: we identified a lack of knowledge related to the importance and goals of CVP monitoring the patient's hemodynamic impairment, being essentially an in-service education on the topic. Descriptors: nursing care; central venous pressure; intensive care unit.RESUMOObjetivo: avaliar o conhecimento do enfermeiro sobre a monitorização da pressão venosa central (PVC) em coluna de água em pacientes críticos. Método: estudo exploratório descritivo, quantitativo, realizado em duas unidades de terapia intensiva, com 24 enfermeiros. Os dados foram coletados de janeiro a abril de 2010, com um questionário, agrupados em freqüências absoluta e relativa, sendo expostos em figuras e tabela. O projeto foi encaminhado ao Comitê de Ética em Pesquisa do Hospital São José de Doenças Infecciosas, aprovado com protocolo 055/2009, CAAE 0056.0.042.000-9. Resultados: a maioria era do sexo feminino, com média de idade de 38,2 e 13,4 anos de formado; 45,8% conheciam a definição de PVC e 54,16% relataram corretamente seus valores normais. Embora 62,5% não tenham citado dificuldades relativas à PVC, observou-se dúvidas quanto a posição do cateter venoso central, checagem pelo raio-x e identificação do eixo flebostático do paciente. Conclusões: identificou-se déficit de conhecimento relacionado à importância e objetivos da PVC no acompanhamento da hemodinâmica do paciente grave, sendo essencial uma educação em serviço sobre a temática. Descritores: assistência de enfermagem; pressão venosa central; unidade de terapia intensiva.

Influence of infusion flow rates on central venous pressure measurements through multi-lumen central venous catheters in intensive care

2006 ◽  
Vol 32 (3) ◽  
pp. 460-463 ◽  
Author(s):  
Karim Lakhal ◽  
Martine Ferrandière ◽  
François Lagarrigue ◽  
Colette Mercier ◽  
Jacques Fusciardi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Central Venous Catheters ◽  
Pressure Measurements ◽  
Central Venous ◽  
Flow Rates

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis

2019 ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Mean Arterial Pressure ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods A retrospective study was performed in patients underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the following perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injury: mean arterial pressure, mean perfusion pressure, central venous pressure, and diastolic perfusion pressure. Multivariate regression analysis was conducted to identify the independent hemodynamic predictors for the development of acute kidney injury. Subgroup analysis was further performed in patients with chronic hypertension. Results Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

Abstract 369: Noninvasive Cerebral Perfusion Pressure and Neurologic Outcome in Post-cardiac Arrest Patients with Targeted Temperature Management

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Minjung K Chae ◽  
Sung Eun Lee ◽  
Sumin Cho ◽  
Taeyoung Kim ◽  
Dukyong Yoon
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Flow Velocity ◽  
Cerebral Perfusion Pressure ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Cerebral Monitoring

Introduction: Hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and long-term neurologic disability in survivors of cardiac arrest. Recently, the role of cerebral monitoring is emphasized for individualizing therapy and mitigating secondary brain injury in HIBI patients after return of spontaneous circulation (ROSC). The first step of cerebral monitoring is checking the driving force by cerebral perfusion pressure (CPP). However, as CPP is calculated by mean arterial pressure (MAP) minus intracranial pressure (ICP), the process of obtaining ICP is invasive. Noninvasive CPP can be estimated by parameters obtained from transcranial doppler (TCD). Therefore, we aimed to investigate non-invasively measured CPP from TCD and its association with neurologic outcome in post cardiac arrest patients that underwent targeted temperature management (TTM). Methods: This retrospective single-center study included patients who had been treated with TTM following cardiac arrest and who underwent TCD evaluation between July 2017 and July 2019. We aimed to perform TCD evaluation within 48h of ROSC, but sometimes this could not be achieved due to limited resources. Patients with TCD that was performed after 72 hours were excluded. The MFV was calculated using the peak systolic flow velocity (PSV) and the end-diastolic flow velocity (EDV) as below. Two methods of estimating CPP non-invasively was calculated as below.MFV = PSV+(EDVх2) / 3 eCPP_A= MAP*diastolic FVmca/MFVmca + 14eCPP_B= MFVmca*(MAP-DBP)/FVmean-FVdia Results: Table 1. Baseline characteristics of study population Data are presented as mean (standard deviation), number (%) or median (interquartile range).OHCA, out of hospital cardiac arrest; CPR, cardiopulmonary resuscitation; AED, automated external defibrillator; TCD, transcranial doppler; CPP, cerebral perfusion pressure. Table 2. Cut off values and diagnostic values in predicting poor neurologic outcome with 100% specificityCPP, cerebral perfusion pressure. Conclusion: eCPP cut off values of <50 mmHg and <60mmHg predicted poor neurological outcome with high specificity. This study suggests that eCPP obtained from TCD may be feasible to predict neurologic outcome.

Sign in / Sign up

Export Citation Format

Share Document