Úvod: Intenzivní léčba pacientů po těžkém poranění mozku je v časné posttraumatické fázi zásadní s hlediska prognózy pacientů. Těžká poranění mozku jsou zatížena vysokou mortalitou. Dle výsledků některých studií 40 až 60 % pacientů ukončí léčbu s neuspokojivým výsledkem. Komplexní invazivní monitoring umožní detailnější zhodnocení aktuálního stavu pacientů a pomůže včas zahájit adekvátní terapii. Materiál a metody: V rámci pilotní studie byla použita unikátní metoda přímého kontinuálního měření průtoku krve mozkem (CBF), srovnávali jsme benefit této metody v korelaci s jinými, již zavedenými metodami. Celkem bylo analyzováno pět pacientů po těžkém poranění mozku, u kterých jsme ihned po příjmu kontinuálně invazivně monitorovali intrakraniální tlak, mozkový perfuzní tlak, průtok krve mozkovou tkání a hladinu tkáňového kyslíku. Pacienti byli léčeni konzervativně i operačně. V rámci skupiny jsme analyzovali vliv jednotlivých monitorovacích modalit a jejich kombinací na léčebnou strategii u těchto pacientů, přičemž jsme se zaměřili na přínos přímého kontinuálního měření CBF. Výsledky: Všechny sledované parametry vzájemně korelovaly, vzestup ICP byl následován poklesem CPP, mozkové perfuze (CBF) a hladin tkáňového kyslíku (p < 0,01). Sledované parametry reagovaly na změnu terapie a patologické hodnoty byly indikátorem neurochirurgické intervence. Závěr: Komplexní monitoring pacientů po těžkém poranění mozku zkvalitňuje intenzivní léčbu těchto pacientů a podává ucelenější obraz o procesech běžících v poškozené mozkové tkáni. Přímé měření CBF napomáhá zhodnocení stavu pacienta a v kombinaci s dalšími metodami by mohlo urychlit výběr vhodné léčebné modality, což by v konečném důsledku mohlo zlepšit celkový výsledek léčby.
Introduction: Intensive treatment of patients in the early post-traumatic phase after severe brain injury is fundamental to the outcome of the treatment. Severe brain injuries are burdened with high mortality. According to the results of some studies, 40% to 60% of the treatments of such patients end in unsatisfactory fashion. Comprehensive invasive monitoring may enable more detailed evaluation of the current status of patients and help the initiation of adequate therapy in good time. Material and methods: A pilot study has employed a unique method for direct continuous measurement of cerebral blood flow (CBF). We compared the benefits of this method with other, established methods. A total of 5 patients were analyzed after severe brain injury. Immediately upon presentation, invasive continuous monitoring of intracranial pressure, cerebral perfusion pressure, blood flow to brain tissue and tissue oxygen levels was begun. Patients were treated conservatively or surgically. We analyzed the influence of different monitoring modalities within the group and the combinations of treatment strategy for these patients, with particular reference to the benefits of direct continuous measurement of CBF. Results: All the parameters studied correlated with one another, a rise in ICP was followed by a decrease of CPP, cerebral perfusion (CBF) and tissue oxygen levels (p <0.01). The parameters monitored responded to changes of therapy and deviations in parameters indicated neurosurgical intervention. Conclusion: Comprehensive monitoring of patients after severe brain injury improves intensive treatment in these patients and provides a more comprehensive picture of the several processes running in the damaged brain tissue. Direct measurement of CBF helps to assess the patient's condition and, in combination with other methods, could accelerate the selection of appropriate therapeutic modalities, which might ultimately improve the overall outcome of treatment.
- Keywords
- těžká poranění mozku, multimodální monitoring, průtok krve mozkem,
- MeSH
- Diagnostic Techniques, Neurological utilization MeSH
- Intracranial Pressure physiology MeSH
- Humans MeSH
- Monitoring, Physiologic methods utilization MeSH
- Cerebrovascular Circulation physiology MeSH
- Neurosurgical Procedures methods utilization MeSH
- Perfusion MeSH
- Pilot Projects MeSH
- Brain Injuries diagnosis complications therapy MeSH
- Blood Flow Velocity physiology MeSH
- Oxygen Consumption physiology MeSH
- Statistics as Topic MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Humans MeSH
In the pulmonary circulation, resistive and compliant properties overlap in the same vessels. Resistance varies nonlinearly with pressure and flow; this relationship is driven by the elastic properties of the vessels. Linehan et al. correlated the mean pulmonary arterial pressure and mean flow with resistance using an original equation incorporating the distensibility of the pulmonary arteries. The goal of this study was to validate this equation in an in vivo porcine model. In vivo measurements were acquired in 6 pigs. The distensibility coefficient (DC) was measured by placing piezo-electric crystals around the pulmonary artery (PA). In addition to experiments under pulsatile conditions, a right ventricular (RV) bypass system was used to induce a continuous pulmonary flow state. The Linehan et al. equation was then used to predict the pressure from the flow under continuous flow conditions. The diameter-derived DC was 2.4%/mmHg (+/-0.4%), whereas the surface area-based DC was 4.1 %/mmHg (+/-0.1%). An increase in continuous flow was associated with a constant decrease in resistance, which correlated with the diameter-based DC (r=-0.8407, p=0.044) and the surface area-based DC (r=-0.8986, p=0.028). In contrast to the Linehan et al. equation, our results showed constant or even decreasing pressure as flow increased. Using a model of continuous pulmonary flow induced by an RV assist system, pulmonary pressure could not be predicted based on the flow using the Linehan et al. equation. Measurements of distensibility based on the diameter of the PA were inversely correlated with the resistance.
- MeSH
- Acid-Base Equilibrium MeSH
- Child MeSH
- Intensive Care, Neonatal methods MeSH
- Intubation, Intratracheal MeSH
- Infant MeSH
- Humans MeSH
- Blood Pressure Monitors MeSH
- Cerebrovascular Circulation physiology MeSH
- Infant, Newborn MeSH
- Blood Flow Velocity physiology MeSH
- Respiration, Artificial MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Infant, Newborn MeSH
