Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands.
Regionale Ambulancevoorziening Hollands Midden, Research and Development, Vondellaan 43, 2332AA, Leiden, The Netherlands.
Scand J Trauma Resusc Emerg Med. 2021 Jun 30;29(1):87. doi: 10.1186/s13049-021-00904-3.
Ambulance drivers in the Netherlands are trained to drive as fluent as possible when transporting a head injured patient to the hospital. Acceleration and deceleration have the potential to create pressure changes in the head that may worsen outcome. Although the idea of fluid shift during braking causing intra cranial pressure (ICP) to rise is widely accepted, it lacks any scientific evidence. In this study we evaluated the effects of driving and deceleration during ambulance transportation on the intra cranial pressure in supine position and 30 upright position.
Participants were placed on the ambulance gurney in supine position. During driving and braking the optical nerve sheath diameter (ONSD) was measured with ultrasound. Because cerebro spinal fluid percolates in the optical nerve sheath when ICP rises, the diameter of this sheath will distend if ICP rises during braking of the ambulance. The same measurements were taken with the headrest in 30 upright position.
Mean ONSD in 20 subjects in supine position increased from 4.80 (IQR 4.80-5.00) mm during normal transportation to 6.00 (IQR 5.75-6.40) mm (p < 0.001) during braking. ONSD's increased in all subjects in supine position. After raising the headrest of the gurney 30 mean ONSD increased from 4.80 (IQR 4.67-5.02) mm during normal transportation to 4.90 (IQR 4.80-5.02) mm (p = 0.022) during braking. In 15 subjects (75%) there was no change in ONSD at all.
ONSD and thereby ICP increases during deceleration of a transporting vehicle in participants in supine position. Raising the headrest of the gurney to 30 degrees reduces the effect of breaking on ICP.
荷兰的救护车驾驶员在将头部受伤的患者送往医院时，接受了尽可能流畅驾驶的培训。加速和减速有可能在头部产生压力变化，从而使预后恶化。尽管制动时发生流体移位导致颅内压（ICP）升高的想法已被广泛接受，但尚无任何科学证据。在这项研究中，我们评估了在仰卧位和 30 度直立位时救护车运输过程中的驾驶和减速对颅内压的影响。
参与者被放置在救护车的轮床上，处于仰卧位。在驾驶和制动过程中，使用超声测量视神经鞘直径（ONSD）。由于脑脊液在 ICP 升高时会渗透到视神经鞘中，因此如果救护车制动时 ICP 升高，该鞘的直径将膨胀。在头枕处于 30 度直立位置时，进行了相同的测量。
在 20 名仰卧位受试者中，ONSD 平均值从正常运输时的 4.80（IQR 4.80-5.00）mm 增加到制动时的 6.00（IQR 5.75-6.40）mm（p<0.001）。所有仰卧位受试者的 ONSD 均增加。将轮床的头枕抬高 30 度后，ONSD 的平均值从正常运输时的 4.80（IQR 4.67-5.02）mm 增加到制动时的 4.90（IQR 4.80-5.02）mm（p=0.022）。在 15 名受试者（75％）中，ONSD 根本没有变化。
在仰卧位参与者中，运输车辆减速时，ONSD 增加，从而 ICP 增加。将轮床的头枕抬高至 30 度可减少制动对 ICP 的影响。
