PDF(Pubmed)
Abstract：
UNASSIGNED: Intracranial pressure (ICP)--guided therapy is the standard of care in the management of severe traumatic brain injury (TBI). Ideal ICP monitoring technique is not yet available, based on its risks associated with bleeding, infection, or its unavailability at major centers. Authors propose that ICP can be gauged based on measuring pressures of other anatomical cavities, for example, the abdominal cavity. Researchers explored the possibility of monitoring intra-abdominal pressure (IAP) to predict ICP in severe TBI patients.
UNASSIGNED: We measured ICP and IAP in severe TBI patients. ICP was measured using standard right frontal external ventricular drain (EVD) insertion and connecting it to the transducer. IAP was measured using a well-established technique of vesical pressure measurement through a manometer.
UNASSIGNED: A total of 28 patients (n = 28) with an age range of 18-65 years (mean of 32.36 years ± 13.52 years [Standard deviation]) and the median age of 28.00 years with an interquartile range (21.00-42.00 years) were recruited in this prospective study. About 57.1% (n = 16) of these patients were in the age range of 18-30 years. About 92.9% (n = 26) of the patients were male. The most common mode of injury (78.6%) was road traffic accidents (n = 22) and the mean Glasgow Coma Scale at presentation was 4.04 (range 3-9). The mean ICP measured at the presentation of this patient cohort was 20.04 mmHg. This mean ICP (mmHg) decreased from a maximum of 20.04 at the 0 h\' time point (at the time of insertion of EVD) to a minimum of 12.09 at the 96 hr time point. This change in mean ICP (from 0 h to 96 h) was found to be statistically significant (Friedman Test: χ2 = 87.6, P ≤ 0.001). The mean IAP (cmH2O) decreased from a maximum of 16.71 at the 0 h\' time point to a minimum of 9.68 at the 96 h\' time point. This change was statistically significant (Friedman Test: χ2 = 71.8, P ≤ 0.001). The per unit percentage change in IAP on per unit percentage change in ICP we observed was correlated to each other. The correlation coefficient between these variables varied from 0.71 to 0.89 at different time frames. It followed a trend in a directly proportional manner and was found to be statistically significant (P < 0.001) in each time frame of the study. The rise in one parameter followed the rise in another parameter and vice versa.
UNASSIGNED: In this study, we established that the ICP of severe TBI patients correlates well with IAP at presentation. This correlation was strong and constant, irrespective of the timeframe during the treatment and monitoring. This study also established that draining cerebrospinal fluid to decrease ICP in severe TBI patients is reflected in IAP. The study validates that IAP is a strong proxy of ICP in severe TBI patients.
UNASSIGNED: We measured ICP and IAP in severe TBI patients. ICP was measured using standard right frontal external ventricular drain (EVD) insertion and connecting it to the transducer. IAP was measured using a well-established technique of vesical pressure measurement through a manometer.
UNASSIGNED: A total of 28 patients (n = 28) with an age range of 18-65 years (mean of 32.36 years ± 13.52 years [Standard deviation]) and the median age of 28.00 years with an interquartile range (21.00-42.00 years) were recruited in this prospective study. About 57.1% (n = 16) of these patients were in the age range of 18-30 years. About 92.9% (n = 26) of the patients were male. The most common mode of injury (78.6%) was road traffic accidents (n = 22) and the mean Glasgow Coma Scale at presentation was 4.04 (range 3-9). The mean ICP measured at the presentation of this patient cohort was 20.04 mmHg. This mean ICP (mmHg) decreased from a maximum of 20.04 at the 0 h\' time point (at the time of insertion of EVD) to a minimum of 12.09 at the 96 hr time point. This change in mean ICP (from 0 h to 96 h) was found to be statistically significant (Friedman Test: χ2 = 87.6, P ≤ 0.001). The mean IAP (cmH2O) decreased from a maximum of 16.71 at the 0 h\' time point to a minimum of 9.68 at the 96 h\' time point. This change was statistically significant (Friedman Test: χ2 = 71.8, P ≤ 0.001). The per unit percentage change in IAP on per unit percentage change in ICP we observed was correlated to each other. The correlation coefficient between these variables varied from 0.71 to 0.89 at different time frames. It followed a trend in a directly proportional manner and was found to be statistically significant (P < 0.001) in each time frame of the study. The rise in one parameter followed the rise in another parameter and vice versa.
UNASSIGNED: In this study, we established that the ICP of severe TBI patients correlates well with IAP at presentation. This correlation was strong and constant, irrespective of the timeframe during the treatment and monitoring. This study also established that draining cerebrospinal fluid to decrease ICP in severe TBI patients is reflected in IAP. The study validates that IAP is a strong proxy of ICP in severe TBI patients.
摘要：
■颅内压（ICP）指导治疗是严重创伤性脑损伤（TBI）的护理标准。目前尚无理想的ICP监测技术，基于其与出血相关的风险，感染,或者它在主要中心不可用。作者提出，ICP可以基于测量其他解剖腔的压力来测量，例如,腹腔。研究人员探索了监测腹内压（IAP）以预测严重TBI患者ICP的可能性。
■我们测量了重度TBI患者的ICP和IAP。使用标准右额外部心室引流（EVD）插入并将其连接到换能器来测量ICP。IAP是通过压力计使用公认的膀胱压力测量技术进行测量的。
■这项前瞻性研究共招募了28名患者（n=28），年龄范围为18-65岁（平均32.36岁±13.52岁[标准差]），年龄中位数为28.00岁，四分位距范围（21.00-42.00岁）。这些患者中约有57.1％（n=16）的年龄在18-30岁之间。约92.9%(n=26)的患者为男性。最常见的伤害模式（78.6％）是道路交通事故（n=22），平均格拉斯哥昏迷评分为4.04（范围3-9）。在该患者队列介绍时测得的平均ICP为20.04mmHg。该平均ICP(mmHg)从0小时时间点(在插入EVD时)的最大值20.04下降到96小时时间点的最小值12.09。平均ICP的这种变化（从0h到96h）具有统计学意义（弗里德曼检验：χ2=87.6，P≤0.001）。平均IAP(cmH2O)从0小时时间点的最大值16.71下降到96小时时间点的最小值9.68。这一变化具有统计学意义(Friedman检验:χ2=71.8,P≤0.001)。我们观察到的IAP每单位百分比变化与ICP每单位百分比变化之间相互关联。这些变量之间的相关系数在不同的时间范围从0.71变化到0.89。它以直接成比例的方式遵循趋势，并且在研究的每个时间范围内都具有统计学意义（P<0.001）。一个参数的上升跟随另一个参数的上升,反之亦然。
■在这项研究中，我们确定重症TBI患者的ICP与就诊时的IAP有很好的相关性.这种相关性很强而且恒定，无论治疗和监测期间的时间范围。这项研究还确定，IAP反映了引流脑脊液以降低严重TBI患者的ICP。该研究证实IAP是重度TBI患者ICP的有力代表。
■我们测量了重度TBI患者的ICP和IAP。使用标准右额外部心室引流（EVD）插入并将其连接到换能器来测量ICP。IAP是通过压力计使用公认的膀胱压力测量技术进行测量的。
■这项前瞻性研究共招募了28名患者（n=28），年龄范围为18-65岁（平均32.36岁±13.52岁[标准差]），年龄中位数为28.00岁，四分位距范围（21.00-42.00岁）。这些患者中约有57.1％（n=16）的年龄在18-30岁之间。约92.9%(n=26)的患者为男性。最常见的伤害模式（78.6％）是道路交通事故（n=22），平均格拉斯哥昏迷评分为4.04（范围3-9）。在该患者队列介绍时测得的平均ICP为20.04mmHg。该平均ICP(mmHg)从0小时时间点(在插入EVD时)的最大值20.04下降到96小时时间点的最小值12.09。平均ICP的这种变化（从0h到96h）具有统计学意义（弗里德曼检验：χ2=87.6，P≤0.001）。平均IAP(cmH2O)从0小时时间点的最大值16.71下降到96小时时间点的最小值9.68。这一变化具有统计学意义(Friedman检验:χ2=71.8,P≤0.001)。我们观察到的IAP每单位百分比变化与ICP每单位百分比变化之间相互关联。这些变量之间的相关系数在不同的时间范围从0.71变化到0.89。它以直接成比例的方式遵循趋势，并且在研究的每个时间范围内都具有统计学意义（P<0.001）。一个参数的上升跟随另一个参数的上升,反之亦然。
■在这项研究中，我们确定重症TBI患者的ICP与就诊时的IAP有很好的相关性.这种相关性很强而且恒定，无论治疗和监测期间的时间范围。这项研究还确定，IAP反映了引流脑脊液以降低严重TBI患者的ICP。该研究证实IAP是重度TBI患者ICP的有力代表。
