Division of Neurosurgery, Main Line Health, Wynnewood, Pennsylvania, USA.
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2019 Oct;130:e62-e67. doi: 10.1016/j.wneu.2019.05.195. Epub 2019 Jun 10.
Multimodality monitoring is used frequently to guide care of patients with severe acute brain injury. The aim of this study was to examine the safety and reliability of multimodality monitoring.
From a prospective observational database at a Level I trauma center, 501 patients, including 300 men and 201 women (mean age 58 ± 39 years) were identified retrospectively. Each patient received a triple-lumen bolt and 3 monitors: intracranial pressure, brain temperature, and brain oxygen. Intensive care unit and hospital records were examined to identify complications, reasons for device replacement, malfunction and infection. Head computed tomography (CT) scans performed before and after the monitors were inserted were examined for evidence of monitor-related adverse effects.
A total of 696 triple-lumen bolts were placed. Median duration of monitoring was 78.88 hours (interquartile range, 33.0-133.2 hours). Bilateral monitors were inserted in 22 (3.16%) patients. Ten (1.43%) monitors were replaced to allow magnetic resonance imaging, and 40 (5.74%) monitors were replaced to facilitate additional cranial surgery. Of 35 (5.02%) monitors that were replaced because they were thought to not be functioning properly, 19 (54.29%) were subsequently found to be functioning normally. Follow-up CT scans were compared with CT scans obtained before insertion of monitors; 9 (2.13%) small contusions and 10 (2.36%) extra-axial hematomas associated with the devices were identified. Based on the CT findings, the hematomas were thought to be associated with the insertion technique rather than the device; 4 hematomas required treatment. Twenty-two (3.16%) devices were incorrectly placed (e.g., the probe was in an infarct or an already existing contusion). Only 1 associated infection was identified.
Placement of intracranial monitors for multimodality neuromonitoring using a triple-lumen bolt appears to be safe. The complication rate is similar to published complication rates for single-lumen bolts and single monitors.
多模态监测常用于指导严重急性脑损伤患者的治疗。本研究旨在评估多模态监测的安全性和可靠性。
我们从一家一级创伤中心的前瞻性观察数据库中回顾性地确定了 501 例患者（包括 300 名男性和 201 名女性，平均年龄为 58 ± 39 岁）。每位患者均接受了三腔螺栓和 3 种监测仪的置入：颅内压、脑温、脑氧。检查重症监护病房和医院记录以确定并发症、更换设备的原因、故障和感染。检查置入监测仪前后的头部 CT 扫描，以确定是否存在与监测仪相关的不良影响。
共置入 696 个三腔螺栓。监测中位数持续时间为 78.88 小时（四分位间距，33.0-133.2 小时）。22 例（3.16%）患者双侧置入了监测仪。10 个（1.43%）监测仪因需要行磁共振成像而更换，40 个（5.74%）监测仪因需要进行额外的颅部手术而更换。35 个（5.02%）因认为监测仪功能异常而更换的监测仪中，19 个（54.29%）随后发现功能正常。对有随访 CT 扫描的患者与置入监测仪前的 CT 扫描进行了比较，发现 9 个（2.13%）小挫伤和 10 个（2.36%）与设备相关的硬膜外血肿。根据 CT 结果，血肿被认为与置入技术而非设备有关；4 个血肿需要治疗。22 个（3.16%）设备置入位置不正确（例如，探头位于梗死灶或已存在的挫伤处）。仅发现 1 例相关感染。
使用三腔螺栓进行颅内监测仪的多模态神经监测的置入似乎是安全的。并发症发生率与单腔螺栓和单监测仪的发表并发症发生率相似。
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