ABSTRACT
The management of intracranial pressure (ICP) is a factor in outcome of patients with head trauma. However, recent studies have revealed that the current strategies, which have been applied to control ICP for adequate cerebral perfusion, are unsatisfactory. Against this background, the efficacy of short-term infusions of hypertonic saline on ICP was investigated. In severely head injured (SHI) patients, hypertonic saline (100 ml 10% NaCl) was administered when standard agents (mannitol, sorbitol, THAM) failed in reducing ICP. To evaluate the pressure reduction after saline infusions the resulting ICP relaxations were analysed statistically in respect to the parameters amplitude, duration and dynamic behaviour of the ICP responses. In 42 randomized relaxations, the relative ICP decrease was 43% [28%-58%] (median [interquartile range]). The corresponding pressure drop was 18 mmHg [15-27 mm Hg]. Relaxations lasted for 93 min [64-126 min] and a relative ICP minimum was reached 26 min [12-33 min] after infusion. In the individual cases the temporal course of the parameters amplitude and decline interval depict a tendency toward lower and higher values, respectively, under conditions of a generally increasing ICP. As expected, the infusion of hypertonic saline reduces ICP in patients suffering from SHI. The pressure drop, duration and dynamic behaviour are suspected to depend both on the pressure level to reduce and concomitant medications.
Subject(s)
Brain Injuries/therapy , Intracranial Hypertension/therapy , Saline Solution, Hypertonic/administration & dosage , Adolescent , Adult , Aged , Brain Injuries/physiopathology , Critical Care , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Infusions, Intravenous , Intracranial Hypertension/physiopathology , Intracranial Pressure/drug effects , Intracranial Pressure/physiology , Male , Monitoring, Physiologic , Treatment OutcomeABSTRACT
Prediction of outcome after shunt-therapy in chronic hydrocephalus syndrome is uncertain. Pathology reveals an impairment of cerebral blood flow (CBF). Based on this, we evaluated CBF and its significance for the assessment of prognosis. In 21 patients (mean age 69 years) selected for surgery, CBF was measured by PET (15O-H2O) before, about one week and 7 months (n = 14) after shunting. CBF was computed by a 1-compartmental model in the territories of the ACA, MCA and PCA. One PET slice in the height of the maximum projection of both cellae mediae was chosen. CBF data were standardized by cluster analysis. Three CBFClusters with significantly different CBF levels prior to shunting in the ACA, MCA and PCA territory, respectively, referred to the sample average (38.2 ml/100 ml/min) were found. These CBFClusters differed in clinical outcome: almost 50% and 90% of patients improved clinically in CBFCluster I, with a perfusion level lower than average, after one week and 7 months, respectively. In contrast, patients of CBFCluster II with an average perfusion did not improve. CBF changes 7 months after shunting related to global CBF before surgery showed a relationship with the clinical course. Clinical outcome corresponded with preoperative global CBF values. Cerebral blood flow lower than average forecasts clinical improvement. Our results suggest that measurement of CBF adds to the indication for surgery.
