Intracranial pressure dynamics and cerebral vasomotor reactivity in community-acquired bacterial meningitis during neurointensive care

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Fältnamn	Indikatorer	Metadata
000		03829naa a2200349 4500
001		oai:DiVA.org:uu-460155
003		SwePub
008		211202s2022 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4601552 URI
024	7	a https://doi.org/10.3171/2021.2.JNS21482 DOI
040		a (SwePub)uu
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Svedung-Wettervik, Teodoru Uppsala universitet,Enblad: Neurokirurgi4 aut0 (Swepub:uu)teosv951
245	1 0	a Intracranial pressure dynamics and cerebral vasomotor reactivity in community-acquired bacterial meningitis during neurointensive care
264	1	b American Association of Neurological Surgeons,c 2022
338		a print2 rdacarrier
520		a OBJECTIVE: Community-acquired bacterial meningitis (CABM) is a severe condition associated with high mortality. In this study the first aim was to evaluate the incidence of intracranial pressure (ICP) insults and disturbances in cerebral vasomotor reactivity and the second aim was to evaluate the management and clinical outcome of CABM patients treated in the neurointensive care unit (NICU).METHODS: CABM patients who were treated in the NICU of Uppsala University Hospital, Sweden, during 2008–2020 were included in the study. Data on demographics, admission variables, treatment, ICP dynamics, vasomotor reactivity, and short-term clinical outcome were evaluated in these patients.RESULTS: Of 97 CABM patients, 81 (84%) received ICP monitoring, of whom 22% had ICP > 20 mm Hg during 5% or more of the monitoring time on day 1, which decreased to 9% on day 3. For those patients with ICP monitoring, 46% required CSF drainage, but last-tier ICP treatment, including thiopental (4%) and decompressive craniectomy (1%), was rare. Cerebral vasomotor reactivity was disturbed, with a mean pressure reactivity index (PRx) above 0.2 in 45% of the patients on day 1, and remained high for the first 3 days. In total, 81 (84%) patients had a favorable outcome (Glasgow Coma Scale motor score [GCS M] 6) at discharge, 9 (9%) patients had an unfavorable outcome (GCS M < 6) at discharge, and 7 (7%) patients died in the NICU. Those with favorable outcome had significantly better cerebral vasomotor reactivity (lower PRx) than the two other outcome groups (p < 0.01).CONCLUSIONS: Intracranial hypertension was frequent following severe CABM and CSF drainage was often sufficient to control ICP. Cerebral vasomotor reactivity was commonly disturbed and associated with poor outcome. Clinical outcome was slightly better than in earlier studies.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Anestesi och intensivvård0 (SwePub)302012 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Anesthesiology and Intensive Care0 (SwePub)302012 hsv//eng
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Neurologi0 (SwePub)302072 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Neurology0 (SwePub)302072 hsv//eng
700	1	a Howells, Timothyu Uppsala universitet,Enblad: Neurokirurgi4 aut0 (Swepub:uu)timho266
700	1	a Ljunghill Hedberg, Annau Uppsala universitet,Infektionssjukdomar4 aut0 (Swepub:uu)annlj496
700	1	a Lewén, Anders,d 1965-u Uppsala universitet,Enblad: Neurokirurgi4 aut0 (Swepub:uu)andelewe
700	1	a Enblad, Peru Uppsala universitet,Enblad: Neurokirurgi4 aut0 (Swepub:uu)perenbla
710	2	a Uppsala universitetb Enblad: Neurokirurgi4 org
773	0	t Journal of Neurosurgeryd : American Association of Neurological Surgeonsg 136:3, s. 831-839q 136:3<831-839x 0022-3085x 1933-0693
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-460155
856	4 8	u https://doi.org/10.3171/2021.2.JNS2148

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Av författaren/redakt...: Svedung-Wettervi ...; Howells, Timothy; Ljunghill Hedber ...; Lewén, Anders, 1 ...; Enblad, Per

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