俯卧位和呼气末正压对颅内压无创估计值的影响：一项初步研究。
Effects of Prone Position and Positive End-Expiratory Pressure on Noninvasive Estimators of ICP: A Pilot Study.
作者信息
Robba Chiara, Bragazzi Nicola Luigi, Bertuccio Alessandro, Cardim Danilo, Donnelly Joseph, Sekhon Mypinder, Lavinio Andrea, Duane Derek, Burnstein Rowan, Matta Basil, Bacigaluppi Susanna, Lattuada Marco, Czosnyka Marek
机构信息
*Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom ∥Brain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge Biomedical Campus, University of Cambridge, Cambridge §Division of Neurosurgery, Department of Clinical Neurosciences, S.George Hospital, University of London, London, UK Departments of #Neurosurgery †Intensive Care, Galliera Hospital ‡Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy ¶Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
出版信息
J Neurosurg Anesthesiol. 2017 Jul;29(3):243-250. doi: 10.1097/ANA.0000000000000295.
BACKGROUND
Prone positioning and positive end-expiratory pressure can improve pulmonary gas exchange and respiratory mechanics. However, they may be associated with the development of intracranial hypertension. Intracranial pressure (ICP) can be noninvasively estimated from the sonographic measurement of the optic nerve sheath diameter (ONSD) and from the transcranial Doppler analysis of the pulsatility (ICPPI) and the diastolic component (ICPFVd) of the velocity waveform.
METHODS
The effect of the prone positioning and positive end-expiratory pressure on ONSD, ICPFVd, and ICPPI was assessed in a prospective study of 30 patients undergoing spine surgery. One-way repeated measures analysis of variance, fixed-effect multivariate regression models, and receiver operating characteristic analyses were used to analyze numerical data.
RESULTS
The mean values of ONSD, ICPFVd, and ICPPI significantly increased after change from supine to prone position. Receiver operating characteristic analyses demonstrated that, among the noninvasive methods, the mean ONSD measure had the greatest area under the curve signifying it is the most effective in distinguishing a hypothetical change in ICP between supine and prone positioning (0.86±0.034 [0.79 to 0.92]). A cutoff of 0.43 cm was found to be a best separator of ONSD value between supine and prone with a specificity of 75.0 and a sensitivity of 86.7.
CONCLUSIONS
Noninvasive ICP estimation may be useful in patients at risk of developing intracranial hypertension who require prone positioning.
背景
俯卧位通气和呼气末正压可改善肺气体交换和呼吸力学。然而，它们可能与颅内高压的发生有关。颅内压（ICP）可通过超声测量视神经鞘直径（ONSD）以及经颅多普勒分析速度波形的搏动性（ICPPI）和舒张成分（ICPFVd）进行无创估计。
方法
在一项对30例接受脊柱手术患者的前瞻性研究中，评估了俯卧位通气和呼气末正压对ONSD、ICPFVd和ICPPI的影响。采用单向重复测量方差分析、固定效应多变量回归模型和受试者工作特征分析来分析数值数据。
结果
从仰卧位变为俯卧位后，ONSD、ICPFVd和ICPPI的平均值显著增加。受试者工作特征分析表明，在无创方法中，平均ONSD测量的曲线下面积最大，这表明它在区分仰卧位和俯卧位之间假设的ICP变化方面最有效（0.86±0.034 [0.79至0.92]）。发现0.43 cm的截断值是仰卧位和俯卧位之间ONSD值的最佳分隔点，特异性为75.0，敏感性为86.7。
结论
对于有发生颅内高压风险且需要俯卧位通气的患者，无创ICP估计可能有用。
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