Analysis of intracranial pressure changes during early versus late percutaneous tracheostomy in a neuro-intensive care unit |
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Authors: | Hasan Kocaeli Ender Korfalı Özgür Taşkapılıoğlu Tekin Özcan |
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Institution: | (1) Department of Neurosurgery, Uludağ University School of Medicine, Bursa, Turkey |
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Abstract: | Background We aimed to investigate intracranial pressure (ICP) changes during early versus late bedside percutaneous tracheostomy (PT)
in a neuro-intensive care unit (NICU).
Methods This study included 30 patients admitted to our NICU for head trauma, subarachnoid haemorrhage, intracerebral haematoma or
brain tumour with a Glasgow Coma Score (GCS) less than 8. These patients also underwent ICP monitoring. Bedside PT was performed
either early (within 7 days of ventilation) or late (after 7 days of ventilation) via the Griggs system. In all patients;
ICP, systemic blood pressure, heart rate, oxygen saturation (Sat O2) and arterial blood gases were recorded 5 min before the procedure, during skin incision, during tracheal cannulation, as
well as 5 min and 10 min after the procedure.
Findings Thirty patients, 18 male and 12 female, with various intracranial pathologies between ages 18 and 78 (mean 38.7 ± 20) were
identified. The admission GCS ranged between 4 and 11 (median 7). Physiological variables did not differ significantly between
the two groups. In the early group, ICP values measured 5 min before the procedure, during skin incision, during tracheal
cannulation, as well as 5 min and 10 min after the procedure were 15.1 ± 5.2, 22 ± 10.1, 28.4 ± 13.7, 17.3 ± 7.1, 13.8 ± 5.0 mmHg,
respectively. In the late group, these values were 14.2 ± 4.5, 17.2 ± 5.5, 21.5 ± 8.0, 15.1 ± 5.3 and 12.4 ± 4.1 mmHg. There
was no significant difference between the early or late groups in terms of ICP increases during these predetermined 5 time
points.
Conclusions In patients with decreased intracranial compliance, a relatively minimally invasive procedure such as PT may lead to significant
increases in ICP. The timing of PT does not seem to influence ICP, mortality, pneumonia or early complications. During the
PT procedure, ICP should be closely monitored and preventive strategies should be instituted in an attempt to prevent secondary
insult to an already severely injured brain. |
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Keywords: | Intracranial pressure monitoring Percutaneous tracheostomy Griggs system Neurointensive care unit |
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