Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1998
Incidence of intracranial hypertension after severe head injury: a prospective study using the Traumatic Coma Data Bank classification.
Intracranial hypertension (ICH) is a frequent finding in patients with a severe head injury. High intracranial pressure (ICP) has been associated with certain computerized tomography (CT) abnormalities. The classification proposed by Marshall et al. based on CT scan findings, uses the status of the mesencephalic cisterns, the degree of midline shift, and the presence or absence of focal lesions to categorize the patients into different prognostic groups. Our aim in this study was to analyze the ICP evolution pattern in the different groups of lesions of this classification. ⋯ 3 patients had a normal CT scan, and none of them presented intracranial hypertension. In diffuse injury type II, the ICP evolution may be quite different. Patients with bilateral brain swelling (Diffuse Injury III) have a high risk of increased ICP (63.2%). Although in our study the frequency of Diffuse Injury IV was low, all patients in this category had a refractory ICP. In the category of evacuated mass lesions, two thirds of the patients presented an intracranial hypertension. In one third, ICP was refractory to treatment. 85% of patients with a non-evacuated mass lesion showed an increased ICP.
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Acta Neurochir. Suppl. · Jan 1998
Comparative StudyClinical evaluation of the Codman microsensor intracranial pressure monitoring system.
The use of the Camino fibre-optic subdural device for measuring Intracranial Pressure (ICP) in patients, has been shown to correlate well with recordings from the "gold standard" intraventricular fluid filled catheter [1]. Following this work, its use has become standard in the clinical monitoring of patients. More recently, laboratory studies have demonstrated accuracy, acceptable drift and high fidelity for the new Codman Microsensor ICP Transducer, a miniature strain gauge mounted on a flexible nylon catheter [3]. Its performance in patients, however, has yet to be fully assessed, in comparative studies. ⋯ These differences could in the majority of cases (excepting the negative drift) be explained by a constant offset of the Codman transducer, as described previously [6]. Further examination of this device is required.
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Acta Neurochir. Suppl. · Jan 1998
Comparative StudyUse of vasopressors to raise cerebral perfusion pressure in head injured patients.
Cerebral ischemia due to low cerebral perfusion pressure (CPP) is the most important secondary effect of severe head injury. There is consensus regarding the maintenance of this pressure at levels above 70 mm Hg. One way to elevate CPP is by increasing mean arterial pressure (MAP). ⋯ The results were: a) the increase of MAP effectively increased CPP without changes in intracranial pressure (ICP) and cerebral extraction of oxygen (CEO2); b) noradrenaline at a dose of 0.5 mg to 5 mg/h was effective and safe and might be considered the drug of choice; c) dopamine was not as effective at a high dose of 10 to 42.5 micrograms/kg/min; d) methoxamine given as a bolus was an effective way to control sudden decreases in MAP. It made the patients more responsive to dopamine. No important undesirable reactions occurred during the study.
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Acta Neurochir. Suppl. · Jan 1998
Comparative StudyAn avoidable methodological failure in intracranial pressure monitoring using fiberoptic or solid state devices.
Failure of intraventricular pressure (IVP) measurement in case of catheter blockage is believed to be eliminated by using intraventricular microtransducers. We report about an avoidable methodological error, which may affect the reliability of IVP measurement with these devices. Intraventricular fiberoptic or solid state devices were implanted in 43 patients considered to be at risk for catheter occlusion. ⋯ In patients treated with Type B devices, no erroneous pressure recording could be identified, irrespective if CSF drainage was performed or not. Transducers, which are simply placed inside the ventriculostomy catheter require fluid coupling. They may fail, either during CSF drainage or when the catheter is blocked or placed within the parenchyma.
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Severe head injury with and without peripheral trauma is the most frequent cause of death and of severe disability up to 45 years. Outcome is determined by two major factors, the extent and nature of the irreversible primary brain damage, and the evolving secondary sequelae, which contrary to the former are responsive in principle to therapeutic intervention. An improvement of outcome from severe head injury can be expected only from an increased efficiency of the measures to prevent secondary brain damage. ⋯ Current results and experiences with establishment of this comprehensive research organization are presented, where no less than 31 hospitals. Institutions and organizations, and a study group of more than 40 physicians, students and statisticians are collaborating. Emerging data appear to be suitable to further improve pertinent aspects of the patient management as a basis to lower the incidence of secondary brain damage from severe head injury.