Sanri Erkman, Karacabey Sinan
Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
J Emerg Med. 2019 Apr;56(4):371-377. doi: 10.1016/j.jemermed.2018.12.043. Epub 2019 Jan 30.
Guidelines recommend placing a cervical collar (c-collar) until spinal injury is excluded. Previous studies have shown that c-collar placement increases intracranial pressure (ICP), which can worsen outcomes for trauma patients who are at risk of increased ICP. Head of bed elevation (HBE) has been found to decrease ICP. However, there is no consensus in the literature for the optimal degree of HBE to decrease ICP.
We aimed to find an optimal HBE degree to decrease ICP to its baseline values in healthy volunteers with increased ICP caused by c-collar.
This is a randomized controlled and blinded study performed in healthy volunteers. Two sonographers measured the optic nerve sheath diameter (ONSD) of each subject's eyes separately for different time points. Then, we calculated a mean ONSD value for five time points: before c-collar placement (T), 5 and 20 min in supine position after c-collar placement (T and T), and 5 and 20 min after HBE (T and T). We randomized the subjects into three groups of HBE: 15, 30, and 45°, and compared the mean ONSD values among groups.
All groups were similar with regard to baseline demographics and ONSD measurements before HBE. We found significant increases in mean ONSD values at T and at T caused by the c-collar. Thirty and forty-five degrees of HBE for 20 min decreased ONSD to its baseline values. The inter-rater reliability of the sonographers was > 0.9.
Our results show that c-collar increases ONSD in healthy volunteers. Elevating the head of the bed 30 and 45° for 20 min decreased ONSD to baseline values.
指南建议在排除脊柱损伤之前佩戴颈托（C型颈托）。先前的研究表明，佩戴C型颈托会增加颅内压（ICP），这可能会使有ICP升高风险的创伤患者的预后恶化。床头抬高（HBE）已被发现可降低ICP。然而，文献中对于降低ICP的最佳HBE程度尚无共识。
我们旨在找到一个最佳的HBE程度，以使因佩戴C型颈托导致ICP升高的健康志愿者的ICP降至基线值。
这是一项在健康志愿者中进行的随机对照双盲研究。两名超声检查人员在不同时间点分别测量每个受试者眼睛的视神经鞘直径（ONSD）。然后，我们计算了五个时间点的平均ONSD值：佩戴C型颈托前（T）、佩戴C型颈托后仰卧位5分钟和20分钟（T₁和T₂）以及床头抬高后5分钟和20分钟（T₃和T₄）。我们将受试者随机分为三组HBE：15°、30°和45°，并比较各组之间的平均ONSD值。
在HBE之前，所有组在基线人口统计学和ONSD测量方面相似。我们发现佩戴C型颈托导致T₁和T₂时平均ONSD值显著增加。30°和45°的HBE持续20分钟可使ONSD降至基线值。超声检查人员之间的评分者间信度＞0.9。
我们的结果表明，佩戴C型颈托会使健康志愿者的ONSD增加。将床头抬高30°和45°持续20分钟可使ONSD降至基线值。
