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- Bellner, Johan, et al.
(författare)
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Transkraniell dopplermätning avspeglar intrakraniellt tryck
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:11, s. 840-844
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Tidskriftsartikel (refereegranskat)abstract
- Vid intrakraniell patologi, speciellt om patienten är medvetslös, är kunskap om det intrakraniella trycket av särskilt värde i neurointensivvård. Intraventrikulär kateter för mätning av intrakraniellt tryck har varit etablerad standard i årtionden. Exakta mätningar är möjliga endast genom invasiva tryckmätare. För att undersöka sambandet mellan intrakraniellt tryck och pulsatilt index, erhållet med transkraniell doppler, har vi genomfört en prospektiv studie. Registreringar av intrakraniellt tryck gjordes parallellt med alla dopplerundersökningar. En stark, signifikant korrelation sågs mellan intrakraniellt tryck och pulsatilt index med en korrelationskoefficient på 0,938. För detektion av ett intrakraniellt tryck >20 mm Hg i en population med intrakraniellt tryck mellan 10 och 40 mm Hg hade metoden – för alla mätningar – en sensitivitet på 0,83 och en specificitet på 0,99. Hos patienter med misstänkt förhöjt intrakraniellt tryck eller hos patienter där förhöjt intrakraniellt tryck måste uteslutas kan mätningar av pulsatilt index vara av stort värde.
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| 2. |
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| 3. |
- Egge, A, et al.
(författare)
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Outcome 1 year after aneurysmal subarachnoid hemorrhage: relation between cognitive performance and neuroimaging
- 2005
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 112:2, s. 76-80
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To assess the cognitive impairment and the association between neuropsychological measures and neuroimaging 1 year after aneurysmal subarachnoid hemorrhage (SAH). Method - Forty-two patients were examined clinically according to Glasgow Outcome Scale (GOS). Computed tomography (CT), single photon emission computed tomography (SPECT) and neuropsychological examination were performed. Results - There were no association between GOS and cognitive impairment index based on the neuropsychological examination. CT showed no sign of cerebral ischemia in 17 (40%) and low attenuating areas indicating cerebral infarction(s) in 25 (60%) patients. A significant correlation (P = 0.01) was observed between the cognitive impairment index and the SPECT index (r = 0.6). SPECT measurement was the only independent predictor for cognitive impairment. Conclusion - GOS is a crude outcome measure and patients classified with good recoveries may have significant cognitive deficits. Neuropsychological examination is the preferred method for outcome evaluation as this method specifically addresses the disabilities affecting patients' everyday life.
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| 4. |
- Egge, A, et al.
(författare)
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Serial single-photon emission computed tomographic and transcranial doppler measurements for evaluation of vasospasm after aneurysmal subarachnoid hemorrhage
- 2005
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Ingår i: Neurosurgery. - 0148-396X. ; 57:2, s. 237-248
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the clinical value of serial single photon-emission computed tomographic (SPECT) measurements after aneurysmal subarachnoid hemorrhage (SAH). Methods: Thirty-two patients were studied prospectively during the first 26 days after SAH with repeated SPELT measurements; clinical examinations, and transcranial Doppler recordings. Time trends were analyzed with a general linear model. A final SPECT measurement was performed after 1 year. Results: A mean of 2.6 (range, 1-5) SPECT measurements revealed a significant (P=0.001) quadratic curve consistent with initial hypoperfusion and then with hyperperfusion during the acute stage. SPELT findings were significantly associated with transcranial Doppler recordings (P=0.016) and clinical assessments (P=0.008). Patients fulfilling clinical and transcranial Doppler criteria for vasospasm demonstrated a more pronounced relative hypoperfusionj hyperperfusion time course. A multivariate logistic regression analysis identified SPECT measurements obtained during Days 7 to 14 after the SAH as the only independent predictor (beta=0.042, P=0.02) for impaired perfusion after 1 year. Conclusion: Serial SPECT measurements after aneurysmal SAH demonstrate that regional changes in cerebral perfusion follow a nonlinear time trend, and repeated measurements are necessary. This observation, as well as the low feasibility of SPECT, restricts the clinical value of such measurements.
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| 5. |
- Elf, Kristin, 1976-
(författare)
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Secondary Insults in Neurointensive Care of Patients with Traumatic Brain Injury
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Traumatic brain injury (TBI) is a major cause of death and disability. Intracranial secondary insults (e.g. intracranial haematoma, brain oedema) and systemic secondary insults (e.g. hypotension, hypoxaemia, hyperthermia) lead to secondary brain injury and affect outcome adversely. In order to minimise secondary insults and to improve outcome in TBI-patients, a secondary insult program and standardised neurointensive care (NIC) was implemented. The aim of this thesis was to describe patient outcome and to explore the occurrence and prognostic value of secondary insults after the implementation.Favourable outcome was achieved in 79% and 6% died of the 154 adult TBI patients treated in the NIC unit 1996-97. In an earlier patient series from the department, 48% made a favourable outcome and 31% died. Hence, the outcome seems to have improved when NIC was standardised and dedicated to avoiding secondary insults. Secondary insults counted manually from hourly recordings on surveillance charts did not hold any independent prognostic information. When utilising a computerised system, which enables minute-by-minute data collection, the proportion of monitoring time with systolic blood pressure > 160 mm Hg decreased the odds of favourable outcome independent of admission variables (odds ratio 0.66). Hyperthermia was related to unfavourable outcome. Hypertension was correlated to hyperthermia and may be a part of a hyperdynamic state aggravating brain oedema. Increased proportion of monitoring time with cerebral perfusion pressure (CPP) < 60 mm Hg increased the odds of favourable outcome (odds ratio 1.59) in patients treated according to an intracranial pressure (ICP)-oriented protocol (Uppsala). In patients given a CPP-oriented treatment (Edinburgh), CPP <60 mm Hg was coupled to an unfavourable outcome. It was shown that pressure passive patients seem to benefit from an ICP-oriented protocol and pressure active patients from a CPP-oriented protocol. The overall outcome would improve if patients were given a treatment fit for their condition.
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| 10. |
- Grände, Per-Olof, et al.
(författare)
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Active cooling in traumatic brain-injured patients: a questionable therapy?
- 2009
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 53, s. 1233-1238
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Tidskriftsartikel (refereegranskat)abstract
- Hypothermia is shown to be beneficial for the outcome after a transient global brain ischaemia through its neuroprotective effect. Whether this is also the case after focal ischaemia, such as following a severe traumatic brain injury (TBI), has been investigated in numerous studies, some of which have shown a tendency towards an improved outcome, whereas others have not been able to demonstrate any beneficial effect. A Cochrane report concluded that the majority of the trials that have already been published have been of low quality, with unclear allocation concealment. If only high-quality trials are considered, TBI patients treated with active cooling were more likely to die, a conclusion supported by a recent high-quality Canadian trial on children. Still, there is a belief that a modified protocol with a shorter time from the accident to the start of active cooling, longer cooling and rewarming time and better control of blood pressure and intracranial pressure would be beneficial for TBI patients. This belief has led to the instigation of new trials in adults and in children, including these types of protocol adjustments. The present review provides a short summary of our present knowledge of the use of active cooling in TBI patients, and presents some tentative explanations as to why active cooling has not been shown to be effective for outcome after TBI. We focus particularly on the compromised circulation of the penumbra zone, which may be further reduced by the stress caused by the difference in thermostat and body temperature and by the hypothermia-induced more frequent use of vasoconstrictors, and by the increased risk of contusional bleedings under hypothermia. We suggest that high fever should be reduced pharmacologically.
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