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Citation |
Akbik OS, Krasberg M, Nemoto EM, Yonas H. J. Neurotrauma 2017; 34(22): 3153-3157. |
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Affiliation |
University of New Mexico, Department of Neurosurgery , MSC10 5615 , 1 University of New Mexico , Albuquerque, New Mexico, United States , 87131-0001 ; HYonas@salud.unm.edu. |
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Copyright |
(Copyright © 2017, Mary Ann Liebert Publishers) |
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DOI |
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PMID |
28614970 |
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Abstract |
The effectiveness of cerebrospinal fluid (CSF) drainage in lowering high intracranial pressure (ICP) is well established in severe traumatic brain injury (TBI). However, recently the use of external ventricular drains and intracranial pressure monitors in traumatic brain injury has come under question. The aim of this retrospective study was to investigate the effect of CSF drainage on brain tissue oxygenation (PbtO2). Using a multimodality monitoring system, we continuously monitored brain tissue oxygenation (PbtO2) and parenchymal ICP during CSF drainage events via a ventriculostomy in 40 patients with severe traumatic brain injury (TBI). Measurements were time-locked continuous recordings on a component neuromonitoring system (CNS) in a Neuroscience Intensive care unit. We further selected for therapeutic CSF drainage events initiated at ICP values above 25mmHg and analyzed the four minute periods before and after drainage for the physiologic variables ICP, cerebral perfusion pressure (CPP), and PbtO2. We retrospectively identified 204 CSF drainage events for ICP EVD-opening values greater than 25mmHg in 23 patients. During the 4 minutes of opened EVD, ICP decreased 5.7 +/- 0.6mmHg; CPP increased by 4.1+/-1.2mmHg; and PbtO2 increased by 1.15+/-0.26 mmHg. ICP, CPP, and PbtO2 all improved with CSF drainage at ICP EVD-opening values above 25mmHg. Although the average PbtO2 changes were small, a clinically significant change in PbtO2 of 5mmHg or greater occurred in 12% of CSF drainage events which was correlated with larger decreases in ICP, displaying a complex relationship between ICP and PbtO2 warranting further studies. Language: en |
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Keywords |
ADULT BRAIN INJURY; CEREBROSPINAL FLUID; Cerebrospinal fluid Brain tissue oxygenation.; TRAUMATIC BRAIN INJURY; Traumatic brain injury |