J Clin Monit Comput - An evaluation and comparison of intraventricular, intraparenchymal, and fluid-coupled techniques for intracranial pressure monitoring in patients with severe traumatic brain injury.

Tópicos

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Resumo

JECTIVE: Intracranial pressure measurements have become one of the mainstays of traumatic brain injury management. Various technologies exist to monitor intracranial pressure from a variety of locations. Transducers are usually placed to assess pressure in the brain parenchyma and the intra-ventricular fluid, which are the two most widely accepted compartmental monitoring sites. The individual reliability and inter-reliability of these devices with and without cerebrospinal fluid diversion is not clear. The predictive capability of monitors in both of these sites to local, regional, and global changes also needs further clarification. The technique of monitoring intraventricular pressure with a fluid-coupled transducer system is also reviewed. There has been little investigation into the relationship among pressure measurements obtained from these two sources using these three techniques.METHODS: Eleven consecutive patients with severe, closed traumatic brain injury not requiring intracranial mass lesion evacuation were admitted into this prospective study. Each patient underwent placement of a parenchymal and intraventricular pressure monitor. The ventricular catheter tubing was also connected to a sensor for fluid-coupled measurement. Pressure from all three sources was measured hourly with and without ventricular drainage.RESULTS: Statistically significant correlation within each monitoring site was seen. No monitoring location was more predictive of global pressure changes or more responsive to pressure changes related to patient stimulation. However, the intraventricular pressure measurements were not reliable in the presence of cerebrospinal fluid drainage whereas the parenchymal measurements remained unaffected.CONCLUSION: Intraparenchymal pressure monitoring provides equivalent, statistically similar pressure measurements when compared to intraventricular monitors in all care and clinical settings. This is particularly valuable when uninterrupted cerebrospinal fluid drainage is desirable.

Resumo Limpo

jectiv intracrani pressur measur becom one mainstay traumat brain injuri manag various technolog exist monitor intracrani pressur varieti locat transduc usual place assess pressur brain parenchyma intraventricular fluid two wide accept compartment monitor site individu reliabl interreli devic without cerebrospin fluid divers clear predict capabl monitor site local region global chang also need clarif techniqu monitor intraventricular pressur fluidcoupl transduc system also review littl investig relationship among pressur measur obtain two sourc use three techniquesmethod eleven consecut patient sever close traumat brain injuri requir intracrani mass lesion evacu admit prospect studi patient underw placement parenchym intraventricular pressur monitor ventricular cathet tube also connect sensor fluidcoupl measur pressur three sourc measur hour without ventricular drainageresult statist signific correl within monitor site seen monitor locat predict global pressur chang respons pressur chang relat patient stimul howev intraventricular pressur measur reliabl presenc cerebrospin fluid drainag wherea parenchym measur remain unaffectedconclus intraparenchym pressur monitor provid equival statist similar pressur measur compar intraventricular monitor care clinic set particular valuabl uninterrupt cerebrospin fluid drainag desir

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