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Balzi APDCC, Otsuki DA, Andrade L, Paiva W, Souza FL, Aureliano LGC, Malbouisson LMS. Can a Therapeutic Strategy for Hypotension Improve Cerebral Perfusion and Oxygenation in an Experimental Model of Hemorrhagic Shock and Severe Traumatic Brain Injury? Neurocrit Care 2023; 39:320-330. [PMID: 37535176 DOI: 10.1007/s12028-023-01802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Restoration of brain tissue perfusion is a determining factor in the neurological evolution of patients with traumatic brain injury (TBI) and hemorrhagic shock (HS). In a porcine model of HS without neurological damage, it was observed that the use of fluids or vasoactive drugs was effective in restoring brain perfusion; however, only terlipressin promoted restoration of cerebral oxygenation and lower expression of edema and apoptosis markers. It is unclear whether the use of vasopressor drugs is effective and beneficial during situations of TBI. The objective of this study is to compare the effects of resuscitation with saline solution and terlipressin on cerebral perfusion and oxygenation in a model of TBI and HS. METHODS Thirty-two pigs weighing 20-30 kg were randomly allocated into four groups: control (no treatment), saline (60 ml/kg of 0.9% NaCl), terlipressin (2 mg of terlipressin), and saline plus terlipressin (20 ml/kg of 0.9% NaCl + 2 mg of terlipressin). Brain injury was induced by lateral fluid percussion, and HS was induced through pressure-controlled bleeding, aiming at a mean arterial pressure (MAP) of 40 mmHg. After 30 min of circulatory shock, resuscitation strategies were initiated according to the group. The systemic and cerebral hemodynamic and oxygenation parameters, lactate levels, and hemoglobin levels were evaluated. The data were subjected to analysis of variance for repeated measures. The significance level established for statistical analysis was p < 0.05. RESULTS The terlipressin and saline plus terlipressin groups showed an increase in MAP that lasted until the end of the experiment (p < 0.05). There was a notable increase in intracranial pressure in all groups after starting treatment for shock. Cerebral perfusion pressure and cerebral oximetry showed no improvement after hemodynamic recovery in any group. The groups that received saline at resuscitation had the lowest hemoglobin concentrations after treatment. CONCLUSIONS The treatment of hypotension in HS with saline and/or terlipressin cannot restore cerebral perfusion or oxygenation in experimental models of HS and severe TBI. Elevated MAP raises intracranial pressure owing to brain autoregulation dysfunction caused by TBI.
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Affiliation(s)
- Ana Paula de Carvalho Canela Balzi
- Anesthesiology Department, Hospital das Clinicas SP, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
- Divisão de Anestesia do ICHC, UTI Cirúrgica Pediátrica, Av. Enéas Carvalho de Aguiar, 255 - 8° Andar, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
| | - Denise Aya Otsuki
- Medical Research Laboratory -LIM-08, Anesthesiology Department, School of Medicine, University of São Paulo, São Paulo, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucia Andrade
- Nephrology Department, Hospital das Clinicas SP, School of Medicine, University of São Paulo, São Paulo, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Wellingson Paiva
- Neurosurgery Department, Hospital das Clinicas SP, School of Medicine, University of São Paulo, São Paulo, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Felipe Lima Souza
- Medical Research Laboratory, Nephrology Department, School of Medicine, University of São Paulo, São Paulo, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Guilherme Cernaglia Aureliano
- Pathology Department, Hospital das Clinicas SP, School of Medicine, University of São Paulo, São Paulo, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Anesthesiology Department, Hospital das Clinicas SP, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Liu H, Pan F, Lei X, Hui J, Gong R, Feng J, Zheng D. Effect of intracranial pressure on photoplethysmographic waveform in different cerebral perfusion territories: A computational study. Front Physiol 2023; 14:1085871. [PMID: 37007991 PMCID: PMC10060556 DOI: 10.3389/fphys.2023.1085871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Intracranial photoplethysmography (PPG) signals can be measured from extracranial sites using wearable sensors and may enable long-term non-invasive monitoring of intracranial pressure (ICP). However, it is still unknown if ICP changes can lead to waveform changes in intracranial PPG signals.Aim: To investigate the effect of ICP changes on the waveform of intracranial PPG signals of different cerebral perfusion territories.Methods: Based on lump-parameter Windkessel models, we developed a computational model consisting three interactive parts: cardiocerebral artery network, ICP model, and PPG model. We simulated ICP and PPG signals of three perfusion territories [anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA), all left side] in three ages (20, 40, and 60 years) and four intracranial capacitance conditions (normal, 20% decrease, 50% decrease, and 75% decrease). We calculated following PPG waveform features: maximum, minimum, mean, amplitude, min-to-max time, pulsatility index (PI), resistive index (RI), and max-to-mean ratio (MMR).Results: The simulated mean ICPs in normal condition were in the normal range (8.87–11.35 mm Hg), with larger PPG fluctuations in older subject and ACA/PCA territories. When intracranial capacitance decreased, the mean ICP increased above normal threshold (>20 mm Hg), with significant decreases in maximum, minimum, and mean; a minor decrease in amplitude; and no consistent change in min-to-max time, PI, RI, or MMR (maximal relative difference less than 2%) for PPG signals of all perfusion territories. There were significant effects of age and territory on all waveform features except age on mean.Conclusion: ICP values could significantly change the value-relevant (maximum, minimum, and amplitude) waveform features of PPG signals measured from different cerebral perfusion territories, with negligible effect on shape-relevant features (min-to-max time, PI, RI, and MMR). Age and measurement site could also significantly influence intracranial PPG waveform.
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Affiliation(s)
- Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Fan Pan
- College of Electronics and Information Engineering, Sichuan University, Chengdu, China
| | - Xinyue Lei
- College of Electronics and Information Engineering, Sichuan University, Chengdu, China
| | - Jiyuan Hui
- Brain Injury Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ru Gong
- Brain Injury Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Junfeng Feng
- Brain Injury Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Junfeng Feng, ; Dingchang Zheng,
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
- *Correspondence: Junfeng Feng, ; Dingchang Zheng,
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Moscote-Salazar L, Janjua T, Florez-Perdomo W. The posterior fossa intracranial pressure monitoring in neurocritical care: It is time to evaluate objectively in forbidden territories. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_72_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Aduen-Carrillo A, Hernandez-Woodbine MJ, Avendaño-Capriles CA, Ayola-Anaya FN. Initial Normotensive Presentation of a Primigravida With Posterior Reversible Encephalopathy Syndrome: A Case Report. Cureus 2021; 13:e19407. [PMID: 34909327 PMCID: PMC8658731 DOI: 10.7759/cureus.19407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by variable neurological manifestations, primarily caused by pathophysiological changes related to cerebral autoregulation that result in radiologically evident vasogenic edema. It is usually associated with hypertensive states, but it is not exclusively related to those. A healthy 18-year-old primigravid woman with no proteinuria or hypertension on admission presented with normotensive PRES. She had an intense diffuse headache that preceded a generalized tonic-clonic seizure. Her neurological status deteriorated, and hypertension was detected afterward. Brain imaging revealed bilateral vasogenic edema in the occipital region. Magnesium sulfate and antihypertensive medications were administered. A cesarean section was performed, and her neurological symptoms subsequently improved, leading to discharge with no complications. This case highlights the importance of suspecting PRES in pregnant patients even in the absence of preeclampsia.
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Dhar R, Sandler RH, Manwaring K, Kostick N, Mansy HA. Noninvasive detection of elevated ICP using spontaneous tympanic membrane pulsation. Sci Rep 2021; 11:21957. [PMID: 34753976 PMCID: PMC8578552 DOI: 10.1038/s41598-021-01079-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022] Open
Abstract
Neurological conditions such as traumatic brain injury (TBI) and hydrocephalus may lead to intracranial pressure (ICP) elevation. Current diagnosis methods rely on direct pressure measurement, while CT, MRI and other expensive imaging may be used. However, these invasive or expensive testing methods are often delayed because symptoms of elevated ICP are non-specific. Invasive methods, such as intraventricular catheter, subdural screw, epidural sensor, lumbar puncture, are associated with an increased risk of infection and hemorrhage. On the other hand, noninvasive, low-cost, accurate methods of ICP monitoring can help avoid risks and reduce costs while expediting diagnosis and treatment. The current study proposes and evaluates a novel method for noninvasive ICP monitoring using tympanic membrane pulsation (TMp). These signals are believed to be transmitted from ICP to the auditory system through the cochlear aqueduct. Fifteen healthy subjects were recruited and TMp signals were acquired noninvasively while the subjects performed maneuvers that are known to change ICP. A custom made system utilizing a stethoscope headset and a pressure transducer was used to perform these measurements. Maneuvers included head-up-tilt, head-down-tilt and hyperventilation. When elevated ICP was induced, significant TMp waveform morphological changes were observed in each subject (p < 0.01). These changes include certain waveform slopes and high frequency wave features. The observed changes were reversed by the maneuvers that decreased ICP (p < .01). The study results suggest that TMp waveform measurement and analysis may offer an inexpensive, noninvasive, accurate tool for detection and monitoring of ICP elevations. Further studies are warranted to validate this technique in patients with pathologically elevated ICP.
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Affiliation(s)
- Rajkumar Dhar
- Biomedical Acoustics Research Laboratory, University of Central Florida, Orlando, FL, 32816, USA.
| | - Richard H Sandler
- Biomedical Acoustics Research Laboratory, University of Central Florida, Orlando, FL, 32816, USA
| | - Kim Manwaring
- Pediatric Neurosurgery, Arnold Palmer Children's Hospital, Orlando, FL, 32806, USA
| | - Nathan Kostick
- College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Hansen A Mansy
- Biomedical Acoustics Research Laboratory, University of Central Florida, Orlando, FL, 32816, USA
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Ribeiro EB, Cobos LD, Rabelo NN, Frigeri G, Vale FAC. Intracranial pressure waveform changes in Alzheimer's disease and mild cognitive impairment. Surg Neurol Int 2021; 12:172. [PMID: 34084600 PMCID: PMC8168790 DOI: 10.25259/sni_48_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Alzheimer’s disease (AD) is known to cause an enormous impairment to the quality of life and impact in the health system; meanwhile, studies show that in the coming years, the number of affected individuals will continue to grow. It is also believed that amnestic mild cognitive impairment (MCI) could represent an early symptomatic form of AD, which precedes dementia. Methods: The present study aimed to evaluate the intracranial pressure (ICP) through a noninvasive method in patients with AD and MCI, seeking for differences when compared to healthy elderlies. This is a cross-sectional, correlational, and observational study of a quantitative character, carried out in a Brazilian city, with patients from the ANEC of the UFSCar. Results: It was found a statistically significant difference between the ICP morphology when analyzing the results in patients with AD and MCI, compared to healthy volunteers. It is known that dementias means a progressive disorder that leads to the loss of independency and function of the patient, although, it is believed that it can be found early ICP alterations in these patients. Nevertheless, considering this is an unprecedent study, it was not possible to compare results with previous studies and literatures. However, the study has a limitation related to the sample size; an expansion of it could possibility lead to different findings. Conclusion: The findings through the ICP measurement could indicate an early diagnosis, which would lead to an early treatment and an improvement in the quality of life of patients with AD. Thus, further investigation and widening studies are encouraged.
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Affiliation(s)
- Estela Barbosa Ribeiro
- Department of Nursing, Nursing Postgraduate Program, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | | | | | - Francisco Assis Carvalho Vale
- Department of Medicine, Nursing Postgraduate Program, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Roberts I, Shakur-Still H, Aeron-Thomas A, Beaumont D, Belli A, Brenner A, Cargill M, Chaudhri R, Douglas N, Frimley L, Gilliam C, Geer A, Jamal Z, Jooma R, Mansukhani R, Miners A, Pott J, Prowse D, Shokunbi T, Williams J. Tranexamic acid to reduce head injury death in people with traumatic brain injury: the CRASH-3 international RCT. Health Technol Assess 2021; 25:1-76. [PMID: 33928903 PMCID: PMC8107835 DOI: 10.3310/hta25260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Tranexamic acid safely reduces mortality in traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury and can cause brain herniation and death. We assessed the effects of tranexamic acid in traumatic brain injury patients. OBJECTIVE To assess the effects of tranexamic acid on death, disability and vascular occlusive events in traumatic brain injury patients. We also assessed cost-effectiveness. DESIGN Randomised trial and economic evaluation. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers and those assessing outcomes were masked to allocation. All analyses were by intention to treat. We assessed the cost-effectiveness of tranexamic acid versus no treatment from a UK NHS perspective using the trial results and a Markov model. SETTING 175 hospitals in 29 countries. PARTICIPANTS Adults with traumatic brain injury within 3 hours of injury with a Glasgow Coma Scale score of ≤ 12 or any intracranial bleeding on computerised tomography scan, and no major extracranial bleeding, were eligible. INTERVENTION Tranexamic acid (loading dose 1 g over 10 minutes then infusion of 1 g over 8 hours) or matching placebo. MAIN OUTCOME MEASURES Head injury death in hospital within 28 days of injury in patients treated within 3 hours of injury. Secondary outcomes were early head injury deaths, all-cause and cause-specific mortality, disability, vascular occlusive events, seizures, complications and adverse events. RESULTS Among patients treated within 3 hours of injury (n = 9127), the risk of head injury death was 18.5% in the tranexamic acid group versus 19.8% in the placebo group (855/4613 vs. 892/4514; risk ratio 0.94, 95% confidence interval 0.86 to 1.02). In a prespecified analysis excluding patients with a Glasgow Coma Scale score of 3 or bilateral unreactive pupils at baseline, the results were 12.5% in the tranexamic acid group versus 14.0% in the placebo group (485/3880 vs. 525/3757; risk ratio 0.89, 95% confidence interval 0.80 to 1.00). There was a reduction in the risk of head injury death with tranexamic acid in those with mild to moderate head injury (166/2846 vs. 207/2769; risk ratio 0.78, 95% confidence interval 0.64 to 0.95), but in those with severe head injury (689/1739 vs. 685/1710; risk ratio 0.99, 95% confidence interval 0.91 to 1.07) there was no apparent reduction (p-value for heterogeneity = 0.030). Early treatment was more effective in mild and moderate head injury (p = 0.005), but there was no obvious impact of time to treatment in cases of severe head injury (p = 0.73). The risk of disability, vascular occlusive events and seizures was similar in both groups. Tranexamic acid is highly cost-effective for mild and moderate traumatic brain injury (base case of £4288 per quality-adjusted life-year gained). CONCLUSION Early tranexamic acid treatment reduces head injury deaths. Treatment is cost-effective for patients with mild or moderate traumatic brain injury, or those with both pupils reactive. FUTURE WORK Further trials should examine early tranexamic acid treatment in mild head injury. Research on alternative routes of administration is needed. LIMITATIONS Time to treatment may have been underestimated. TRIAL REGISTRATION Current Controlled Trials ISRCTN15088122, ClinicalTrials.gov NCT01402882, EudraCT 2011-003669-14, Pan African Clinical Trial Registry PACTR20121000441277. FUNDING The project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 26. See the NIHR Journals Library website for further project information. In addition, funding was provided by JP Moulton Charitable Trust, Joint Global Health Trials (Medical Research Council, Department for International Development and the Wellcome Trust). This project was funded by the NIHR Global Health Trials programme.
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Affiliation(s)
- Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Danielle Beaumont
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Antonio Belli
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Amy Brenner
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Madeleine Cargill
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Rizwana Chaudhri
- Department of Obstetrics and Gynaecology, Rawalpindi Medical University, Rawalpinidi, Pakistan
| | - Nicolas Douglas
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Lauren Frimley
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Gilliam
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Amber Geer
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Zahra Jamal
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashid Jooma
- Department of Surgery, The Aga Khan University Medical College, Karachi, Pakistan
| | - Raoul Mansukhani
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jason Pott
- Emergency Department, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Danielle Prowse
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Temitayo Shokunbi
- Department of Anatomy and Surgery, University of Ibadan, Ibadan, Nigeria
| | - Jack Williams
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Neuromonitoring After Cardiac Arrest: Can Twenty-First Century Medicine Personalize Post Cardiac Arrest Care? Neurol Clin 2021; 39:273-292. [PMID: 33896519 DOI: 10.1016/j.ncl.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac arrest survivors comprise a heterogeneous population, in which the etiology of arrest, systemic and neurologic comorbidities, and sequelae of post-cardiac arrest syndrome influence the severity of secondary brain injury. The degree of secondary neurologic injury can be modifiable and is influenced by factors that alter cerebral physiology. Neuromonitoring techniques provide tools for evaluating the evolution of physiologic variables over time. This article reviews the pathophysiology of hypoxic-ischemic brain injury, provides an overview of the neuromonitoring tools available to identify risk profiles for secondary brain injury, and highlights the importance of an individualized approach to post cardiac arrest care.
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9
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Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure. Sci Rep 2020; 10:13626. [PMID: 32788610 PMCID: PMC7423943 DOI: 10.1038/s41598-020-70614-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/09/2020] [Indexed: 11/08/2022] Open
Abstract
This study investigates the effects of aircraft cabin pressure on intracranial pressure (ICP) elevation of a pneumocephalus patient. We propose an experimental setup that simulates the intracranial hydrodynamics of a pneumocephalus patient during flight. It consists of an acrylic box (skull), air-filled balloon [intracranial air (ICA)], water-filled balloon (cerebrospinal fluid and blood) and agarose gel (brain). The cabin was replicated using a custom-made pressure chamber. The setup can measure the rise in ICP during depressurization to levels similar to that inside the cabin at cruising altitude. ΔICP, i.e. the difference between mean cruising ICP and initial ICP, was found to increase with ICA volume and ROC. However, ΔICP was independent of the initial ICP. The largest ΔICP was 5 mmHg; obtained when ICA volume and ROC were 20 ml and 1,600 ft/min, respectively. The postulated ICA expansion and the subsequent increase in ICP in pneumocephalus patients during flight were successfully quantified in a laboratory setting. Based on the quantitative and qualitative analyses of the results, an ICA volume of 20 ml and initial ICP of 15 mmHg were recommended as conservative thresholds that are required for safe air travel among pneumocephalus patients. This study provides laboratory data that may be used by doctors to advise post-neurosurgical patients if they can safely fly.
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da Silva Bento P, Santiago AD, Vendrame Saes LS, Erbs Pessoa JL, Ockner Silva TL, Schirmer J, de Aguiar Roza B. Loss of Potential Donors Due to Hemodynamic Maintenance. Transplant Proc 2020; 52:1226-1230. [PMID: 32192745 DOI: 10.1016/j.transproceed.2020.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Statistics indicate low utilization of potential donors, where only about one-third are converted into actual donors. In this context, it is plausible to argue that many potential donors are not hemodynamically stable for harvesting multiple organs since the procedures for maintaining parameters of stability may not be a priority in all critical care units in the country. Thus, it is necessary to identify losses of potential donors due to hemodynamic maintenance since reversing this situation enable minimizing mortality on waiting lists. METHODS This was a retrospective quantitative study, based on information sent to Notification, Organ Procurement, and Distribution Centers by reporting hospitals in the state of São Paulo, using the Death Information Form regarding the specifics of each death registered in their intensive care units and emergency rooms. RESULTS Hemodynamic instability contributed to a loss of 537 potential donors, corresponding to 61.9% of failures to obtain potentially transplantable organs. CONCLUSION Of the 33,175 cases of death reported, 867 fulfilled the criteria to be possible and potential donors (ie, patients diagnosed with brain death). Among these cases, 38.1% fulfilled Criterion 3 (ie, they were hemodynamically stable and in ideal organ donation condition). Therefore, this study concludes that losses due to maintenance occurred in 537 brain dead patients. This finding highlights the importance of investing in the development of competencies of professionals who work in critical care units to increase the number of multiple organ and tissue donors and reduce waiting lists.
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Affiliation(s)
| | - Alessandra Duarte Santiago
- Intra-Hospital Commission of Organ and Tissue Donation for Transplant, Hospital São Paulo, São Paulo, Brazil
| | | | | | | | - Janine Schirmer
- Clinical and Surgical Nursing Department, Paulista Nursing School, Federal University of São Paulo, São Paulo, Brazil
| | - Bartira de Aguiar Roza
- Clinical and Surgical Nursing Department, Paulista Nursing School, Federal University of São Paulo, São Paulo, Brazil
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11
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Schuster J, Koulov A, Mahler HC, Detampel P, Huwyler J, Singh S, Mathaes R. In Vivo Stability of Therapeutic Proteins. Pharm Res 2020; 37:23. [DOI: 10.1007/s11095-019-2689-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/16/2019] [Indexed: 01/05/2023]
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12
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Yamin G, Cheecharoen P, Goel G, Sung A, Li CQ, Chang YHA, McDonald CR, Farid N. Automated CT registration tool improves sensitivity to change in ventricular volume in patients with shunts and drains. Br J Radiol 2020; 93:20190398. [PMID: 31825670 DOI: 10.1259/bjr.20190398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE CT is the mainstay imaging modality for assessing change in ventricular volume in patients with ventricular shunts or external ventricular drains (EVDs). We evaluated the performance of a novel fully automated CT registration and subtraction method to improve reader accuracy and confidence compared with standard CT. METHODS In a retrospective evaluation of 49 ventricular shunt or EVD patients who underwent sequential head CT scans with an automated CT registration tool (CT CoPilot), three readers were assessed on their ability to discern change in ventricular volume between scans using standard axial CT images versus reformats and subtraction images generated by the registration tool. The inter-rater reliability among the readers was calculated using an intraclass correlation coefficient (ICC). Bland-Altman tests were performed to determine reader performance compared to semi-quantitative assessment using the bifrontal horn and third ventricular width. McNemar's test was used to determine whether the use of the registration tool increased the reader's level of confidence. RESULTS Inter-rater reliability was higher when using the output of the registration tool (single measure ICC of 0.909 with versus 0.755 without the tool). Agreement between the readers' assessment of ventricular volume change and the semi-quantitative assessment improved with the registration tool (limits of agreement 4.1 vs 4.3). Furthermore, the tool improved reader confidence in determining increased or decreased ventricular volume (p < 0.001). CONCLUSION Automated CT registration and subtraction improves the reader's ability to detect change in ventricular volume between sequential scans in patients with ventricular shunts or EVDs. ADVANCES IN KNOWLEDGE Our automated CT registration and subtraction method may serve as a promising generalizable tool for accurate assessment of change in ventricular volume, which can significantly affect clinical management.
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Affiliation(s)
- Ghiam Yamin
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA
| | - Piyaphon Cheecharoen
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA
| | - Gunjan Goel
- Department of Neurosurgery, University of California San Diego School of Medicine, La Jolla, CA
| | - Andrew Sung
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA
| | - Charles Q Li
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA
| | - Yu-Hsuan A Chang
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA
| | - Carrie R McDonald
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA
| | - Nikdokht Farid
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA
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Cerebral Blood Flow in Low Intracranial Pressure Headaches-What is Known? Brain Sci 2019; 10:brainsci10010002. [PMID: 31861526 PMCID: PMC7016724 DOI: 10.3390/brainsci10010002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
Headaches attributed to low cerebrospinal fluid (CSF) pressure are described as orthostatic headaches caused by spontaneous or secondary low CSF pressure or CSF leakages. Regardless of the cause, CFS leaks may lead to intracranial hypotension (IH) and influence cerebral blood flow (CBF). When CSF volume decreases, a compensative increase in intracranial blood volume and cerebral vasodilatation occurs. Sinking of the brain and traction on pain-sensitive structures are thought to be the causes of orthostatic headaches. Although there are many studies concerning CBF during intracranial hypertension, little is known about CBF characteristics during low intracranial pressure. The aim of this review is to examine the relationship between CBF, CSF, and intracranial pressure in headaches assigned to low CSF pressure.
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Tirado-Caballero J, Muñoz-Nuñez A, Rocha-Romero S, Rivero-Garvía M, Gomez-González E, Marquez-Rivas J. Long-term reliability of the telemetric Neurovent-P-tel sensor: in vivo case report. J Neurosurg 2019; 131:578-581. [PMID: 30168735 DOI: 10.3171/2018.4.jns172988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/02/2018] [Indexed: 02/03/2023]
Abstract
Intracranial pressure (ICP) measurements are imperative for the proper diagnosis and treatment of several neurological disorders. Telemetric sensors have shown their utility for ICP estimation in short-term monitoring in humans. However, their long-term reliability is uncertain. The authors present the case of a 37-year-old woman diagnosed with benign intracranial hypertension and obesity. The patient underwent gastric bypass surgery for ICP control. In order to monitor ICP before and after bariatric surgery, a Neurovent-P-tel sensor was implanted in the left frontal lobe. After gastric bypass, normal ICP values were recorded, and the patient's visual fields improved. However, the patient experienced incapacitating daily headaches. The authors decided to implant a Codman Microsensor ICP transducer in the right frontal lobe to assess the long-term reliability of the Neurovent-P-tel measurements. A comparison of the recordings at 24 and 48 hours showed good correlation and reliability during long-term monitoring with the Neurovent-P-tel, with minimal zero drift after 11 months of implantation.
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Affiliation(s)
- Jorge Tirado-Caballero
- 1Neurosurgery Service, Virgen del Rocío University Hospital, Seville
- 3Group of Applied Neuroscience, Biomedicine Institute of Seville, Spain
| | - Andres Muñoz-Nuñez
- 1Neurosurgery Service, Virgen del Rocío University Hospital, Seville
- 3Group of Applied Neuroscience, Biomedicine Institute of Seville, Spain
| | - Santiago Rocha-Romero
- 1Neurosurgery Service, Virgen del Rocío University Hospital, Seville
- 3Group of Applied Neuroscience, Biomedicine Institute of Seville, Spain
| | - Mónica Rivero-Garvía
- 1Neurosurgery Service, Virgen del Rocío University Hospital, Seville
- 3Group of Applied Neuroscience, Biomedicine Institute of Seville, Spain
| | - Emilio Gomez-González
- 2Group of Interdisciplinary Physics, University of Seville; and
- 3Group of Applied Neuroscience, Biomedicine Institute of Seville, Spain
| | - Javier Marquez-Rivas
- 1Neurosurgery Service, Virgen del Rocío University Hospital, Seville
- 3Group of Applied Neuroscience, Biomedicine Institute of Seville, Spain
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Sawosz P, Kacprzak M, Pulawski P, Morawiec M, Bejm K, Bielacz M, Maniewski R, Liebert A, Dabrowski W. Influence of intra-abdominal pressure on the amplitude of fluctuations of cerebral hemoglobin concentration in the respiratory band. BIOMEDICAL OPTICS EXPRESS 2019; 10:3434-3446. [PMID: 31467788 PMCID: PMC6706036 DOI: 10.1364/boe.10.003434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/04/2019] [Accepted: 05/17/2019] [Indexed: 05/15/2023]
Abstract
An intra-abdominal pressure (IAP) is correlated with cerebral perfusion, in a mechanism of reducing venous outflow. The elevated intra-abdominal pressure leads to an increase in the intracranial pressure and a decrease in the cerebral perfusion pressure. We studied the relationship between the IAP and the cerebral oxygenation with the use of the near infrared spectroscopy technique during a gynecological surgery. The changes in hemoglobin concentrations were analyzed in the time-frequency domain in the frequency band related to respiration. The measurements were carried out in 15 subjects who underwent laparoscopic surgery. During the laparoscopy, the intra-abdominal cavity was insufflated with CO2, which caused a controlled increase in the IAP. It was observed that the amplitudes of respiration-related waves present in hemoglobin concentration signals show an increase of 1.5 to 8.5 times during elevation of the IAP by 15 mmHg.
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Affiliation(s)
- Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Michal Kacprzak
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Przemyslaw Pulawski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Magdalena Morawiec
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Karolina Bejm
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Magdalena Bielacz
- Institute of Tourism and Recreation, State Vocational College of Szymon Szymonowicz, Zamosc, Poland
| | - Roman Maniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Wojciech Dabrowski
- Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
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Misiulis E, Džiugys A, Navakas R, Striūgas N. A fluid-structure interaction model of the internal carotid and ophthalmic arteries for the noninvasive intracranial pressure measurement method. Comput Biol Med 2017; 84:79-88. [DOI: 10.1016/j.compbiomed.2017.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 01/09/2023]
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17
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Torres MU, Delgado LV, Giraldo N, Urueña P, Franco S, Hernández OH. [Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictive factors of a poor prognosis]. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2017; 37:13-19. [PMID: 28527261 DOI: 10.7705/biomedica.v37i2.3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/28/2016] [Indexed: 06/07/2023]
Abstract
Posterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified.A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible encephalopathy syndrome provide opportunities to investigate the susceptibility for the development of this condition and to establish appropriate preventive measures.
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Affiliation(s)
- Moisés Ulises Torres
- Especialización en Medicina Crítica y Cuidados Intensivos, Facultad de Medicina, Universidad CES, Medellín, Colombia.
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