Intracranial Pressure Monitoring as a Part of Multimodal Monitoring Management of Patients with Critical Polytrauma: Correlation between Optimised Intensive Therapy According to Intracranial Pressure Parameters and Clinical Picture [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. 2015; 43(6): 412-417 | DOI: 10.5152/TJAR.2015.56933  

Intracranial Pressure Monitoring as a Part of Multimodal Monitoring Management of Patients with Critical Polytrauma: Correlation between Optimised Intensive Therapy According to Intracranial Pressure Parameters and Clinical Picture

Loredana Luca1, Alexandru Florin Rogobete1, Ovidiu Horea Bedreag1, Mirela Sarandan2, Carmen Alina Cradigati2, Marius Papurica1, Anelore Gruneantu1, Raluca Patrut1, Corina Vernic3, Corina Maria Dumbuleu1, Dorel Sandesc1
1Clinic of Anaesthesia and Intensive Care, Emergency County Hospital ”Pius Brinzeu”, Timisoara, Romania
2Clinic of Anaesthesia and Intensive Care "Casa Austria", Emergency County Hospital ”Pius Brinzeu”, Timisoara, Romania
3Faculty of Medicine, ”Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania

INTRODUCTION: Trauma patient requires a complex therapeutic management because of multiple severe injuries or secondary complications. The most significant injury found in patients with trauma is head injury, which has the greatest impact on mortality. Intracranial pressure (ICP) monitoring is required in severe traumatic head injury because it optimises treatment based on ICP values and cerebral perfusion pressure (CPP).
METHODS: From a total of 64 patients admitted in the intensive care unit (ICU) ‘Casa Austria’, from the Polytraumatology Clinic of the Emergency County Hospital “Pius Brinzeu” Timisoara, Romania, between January 2014 and December 2014; only patients who underwent ICP monitoring (n=10) were analysed. The study population was divided into several categories depending on the time passed since trauma to the time of installation of ICP monitoring (<18 h, 19–24 h and >24 h). Comparisons were made in terms of the number of days admitted in the ICU and mortality between patients with head injury who benefited and those who did not benefit from ICP monitoring.
RESULTS: The results show the positive influence of ICP monitoring on the number of admission days in ICU because of the possibility that the number of admission days to augment therapeutic effects in patients who benefited from ICP monitoring reduces by 1.93 days compared with those who did not undergo ICP monitoring.
DISCUSSION AND CONCLUSION: ICP monitoring and optimizing therapy according to the ICP and CPP has significant influence on the rate of survival. ICP monitoring is necessary in all patients with head trauma injury according to recent guidelines. The main therapeutic goal in the management of the trauma patient with head injury is to minimize the destructive effects of the associated side effects.

Keywords: Intracranial pressure, cerebral perfusion pressure, cerebral blood flow, head injury, traumatic brain injury, multiple trauma patients


Politravmalı Kritik Hastalarda Multimodal Tedavi Yaklaşımının Bir Parçası Olarak İntrakranial Basınç Takibi. İntrakranial Basınç Parametrelerine Göre Optimize Edilmiş Yoğun Terapi ve Klinik Tablo Arasındaki Korelasyon

Loredana Luca1, Alexandru Florin Rogobete1, Ovidiu Horea Bedreag1, Mirela Sarandan2, Carmen Alina Cradigati2, Marius Papurica1, Anelore Gruneantu1, Raluca Patrut1, Corina Vernic3, Corina Maria Dumbuleu1, Dorel Sandesc1
1Clinic of Anaesthesia and Intensive Care, Emergency County Hospital ”Pius Brinzeu”, Timisoara, Romania
2Clinic of Anaesthesia and Intensive Care "Casa Austria", Emergency County Hospital ”Pius Brinzeu”, Timisoara, Romania
3Faculty of Medicine, ”Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania

GİRİŞ ve AMAÇ: Travmalı hastada, çok sayıda ağır yaralanma veya sekonder komplikasyonlar nedeniyle karmaşık bir tedavi yaklaşımı gerekir. Travmalı hastalarda bulunan en önemli yaralanma, ölüm üzerinde en büyük etkiye sahip olan kafa travmasıdır. Ağır travmatik kafa yaralanmasında intrakranial basınç (İKB) takibi gereklidir, çünkü İKB değerlerine ve serebral perfüzyon basıncına (SPB) dayalı tedaviyi optimize etmektedir.
YÖNTEM ve GEREÇLER: Ocak 2014 ve Aralık 2014 arasında Temeşvar, Romanya’da “Pius Brinzeu” Acil Şehir Hastanesinin Politravmatoloji Kliniğinde, “Casa Austria” yoğun bakım ünitesine (YBÜ) başvuran toplam 64 hastadan, sadece İKB takibi yapılan hastalar (n=10) analiz edildi. Çalışma popülasyonu travmadan İKB takibinin kurulumuna kadar geçen zamana bağlı olarak (<18 saat, 19-24 saat,>24 saat) çeşitli kategorilere ayrıldı. Ayrıca İKB takibinden yararlanan ve yararlanmayan kafa travmalı hastalar arasında YBܒnde yatış günü sayıları ve mortalite açısından karşılaştırma yapıldı.
BULGULAR: Bulgular İKB takibinin, terapötik etkiyi artırma ihtimali nedeniyle YBܒde yatış günleri üzerine olumlu etkisini göstermektedir. İKB takibinden yararlanan hastalarda İKB takibi olmayanlara kıyasla 1,93 gün daha az yatış mevcuttu.
TARTIŞMA ve SONUÇ: İKB takibi ve İKB ve SPB’ye göre tedavinin optimize edilmesi sağkalım oranı üzerinde önemli bir etkiye sahiptir. İKB takibi güncel kılavuzlara göre kafa travması yaralanması olan tüm hastalarda gereklidir. Kafa yaralanması olan travmalı hastanın tedavisinde başlıca terapötik hedef ilişkili yan etkilerin tahrip edici etkilerini en aza indirmektir.

Anahtar Kelimeler: İntrakranial basınç, serebral perfüzyon basıncı, serebral kan akımı, kafa yaralanması, travmatik beyin hasarı, çoklu travmalı hastalar


Loredana Luca, Alexandru Florin Rogobete, Ovidiu Horea Bedreag, Mirela Sarandan, Carmen Alina Cradigati, Marius Papurica, Anelore Gruneantu, Raluca Patrut, Corina Vernic, Corina Maria Dumbuleu, Dorel Sandesc. Intracranial Pressure Monitoring as a Part of Multimodal Monitoring Management of Patients with Critical Polytrauma: Correlation between Optimised Intensive Therapy According to Intracranial Pressure Parameters and Clinical Picture. Turk J Anaesthesiol Reanim. 2015; 43(6): 412-417

Corresponding Author: Ovidiu Horea Bedreag, Romania


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