Document Detail


Intracranial compliance as a bed-side monitoring technique in severely head-injured patients.
MedLine Citation:
PMID:  12168297     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A recently developed monitoring technology makes an on-line assessment of intracranial compliance (ICC) possible. Aims of our research: 1. Course and values of ICC (critical threshold: < 0.5 ml/mmHg) in episodes of pathological intracranial pressure (ICP) (> 20 mmHg) and reduced cerebral oxygenation (brain tissue PO2 (PtiO2) < 10 mmHg). 2. Mean ICC in different ages. 3. Relationship between ICC and outcome. 4. Evaluation of ICC as routine monitoring parameter by calculation of s.c. time-of-good-data-quality (TGDQ). Computer data assessment of 7 patients with severe closed head-injury was performed providing 830 hours of data. TGDQ resulted from the formula: TGDQ (%) = artifact free time (min) x 100 (%)/total monitoring time (min). Outcome was assessed 6 months posttrauma (Glasgow Outcome Score (GOS). 1. Analysis revealed 43 episodes of pathologically elevated ICP and 39 of critical ICC. In 17 cases overlapping periods were found. In 9 of these ICC preceded ICP. Reduced cerebral oxygenation was neither related with high ICP nor low ICC. 2. ICC was found to be age-related. At a cut-off-point of 20 mmHg in ICP, ICC in children (< or = 16 years) was 0.9, in adults (17-60 years) 0.7 and in elderly (> 60 years) 0.6 ml/mmHg. 3. Adverse outcome was indicated best by high ICP (up to 45% of monitoring time) followed by low ICC (up to 41% of monitoring time). 4. TGDQ in ICC was 72% compared to 95% in ICP and 98% in PtiO2. In predicting adverse outcome, ICP was equal to ICC. The different ICC in each age class points to the need of age-adjusted thresholds. Further refinements of ICC technology are needed to improve ICC data quality and therefore become a useful tool in neuromonitoring.
Authors:
K L Kiening; W N Schoening; W R Lanksch; A W Unterberg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  81     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2002  
Date Detail:
Created Date:  2002-08-09     Completed Date:  2003-01-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  177-80     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Charité, Virchow Medical Center Humboldt-University at Berlin, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cerebrovascular Circulation / physiology*
Child
Craniocerebral Trauma / physiopathology*
Glasgow Coma Scale
Humans
Intracranial Hypertension / diagnosis,  physiopathology*
Intracranial Pressure / physiology*
Male
Middle Aged
Monitoring, Physiologic / methods*
Oxygen / blood
Point-of-Care Systems
Resuscitation
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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