Aries Marcel J H, de Jong Sytse F, van Dijk J Marc C, Regtien Joost, Depreitere Bart, Czosnyka Marek, Smielewski Peter, Elting Jan Willem J
Department of Critical Care Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Neurocrit Care. 2015 Dec;23(3):347-54. doi: 10.1007/s12028-015-0107-z.
Cerebral autoregulation is increasingly recognized as a factor that requires evaluation when managing poor grade aneurysmal subarachnoidal hemorrhage (aSAH) patients. In this single center pilot study, we investigated whether intraventricular intracranial pressure (ICP) derived when extraventricular drain (EVD) is open can be used to calculate dynamic autoregulation estimates in ICU aSAH patients.
Ten patients with the diagnosis of aSAH as confirmed by computed tomography (CT) and CT-angiography were enrolled. ICP was monitored via a transducer connected to the most proximal side exit of the EVD catheter. From at least 30 min periods of brain monitoring before, during, and after temporarily EVD closure, commonly used indexes of dynamic cerebral autoregulation were calculated.
Preserved pulsatile ICP signals were seen with open EVD. There were no significant changes in parameters describing cerebral autoregulation between EVD open and closed conditions. Power spectra of ABP and ICP showed no significant changes for the selected frequency ranges. There was a small significant increase in absolute ICP [2.4 (3.8) mmHg, p < 0.001] upon short-term EVD closure. Cerebral spinal reserve capacity (RAP index) worsened significantly by short-term EVD closure.
Due to preserved slow fluctuations in the ICP signal, an open EVD system can be used to calculate dynamic autoregulation indices in aSAH patients requiring intensive care monitoring with the pressure measurement from the most proximal part of drain. If these results are confirmed in larger study, this technique can open the way for investigating the role of autoregulation disturbance in aSAH patients.
在管理低级别动脉瘤性蛛网膜下腔出血（aSAH）患者时，脑自动调节越来越被认为是一个需要评估的因素。在这项单中心试点研究中，我们调查了在脑室外引流（EVD）开放时获得的脑室内颅内压（ICP）是否可用于计算重症监护病房（ICU）中aSAH患者的动态自动调节估计值。
纳入10例经计算机断层扫描（CT）和CT血管造影确诊为aSAH的患者。通过连接到EVD导管最近端侧出口的传感器监测ICP。在EVD暂时关闭之前、期间和之后至少30分钟的脑监测期间，计算常用的动态脑自动调节指标。
EVD开放时可见保留的搏动性ICP信号。在EVD开放和关闭状态之间，描述脑自动调节的参数没有显著变化。ABP和ICP的功率谱在选定的频率范围内没有显著变化。短期EVD关闭后，绝对ICP有小幅显著升高[2.4（3.8）mmHg，p<0.001]。短期EVD关闭使脑脊髓储备能力（RAP指数）显著恶化。
由于ICP信号中保留了缓慢波动，开放的EVD系统可用于计算需要重症监护监测的aSAH患者的动态自动调节指数，通过测量引流管最近端的压力来实现。如果这些结果在更大规模的研究中得到证实，这项技术可为研究自动调节紊乱在aSAH患者中的作用开辟道路。
