Continuous Recording of the Ventricular-Fluid Pressure in Patients with Severe Acute Traumatic Brain Injury

Abstract

EASUREMENTS of the spinal-fluid pressure by means of lumbar puncture in cases of acute injury of the head have been repol~ed and the value of such measurements has been discussed by Russell, 17 Munro, 13 Busch, 2 Rowbotham 16 and several other investigators. 1,5 In order to study intracranial dynamics, Ryder et al. TM recorded the spinal-fluid pressure continuously in a few patients with acute injury of the brain. The cerebrospinal-fluid pressure has also been measured in animals after experimentally induced trauma to the head. 3,1~,2~ Obvious interest has thus been shown in the changes of intracranial pressure in traumatic injury of the brain. However, no attempts have been made, either experimentally or clinically, to study, by continuous recording, the variations of this pressure during the acute stage. On the whole, present-day treatment of posttraumatic intracranial hypertension is based on rather fragmentary knowledge. In our department continuous recording of the ventricular-fluid pressure has been used routinely for several years in a total number of 368 nontraumatic eases of intracranial hypertension. In our experience TM the technique has proved to be safe and we have found considerable practical value in controlling the ventricular-fluid pressure. On this basis we decided to use continuous control of the ventricular-fluid pressure in eases of traumatic injury of the brain. This is a preliminary report on the first 30 patients, illustrated by a few representative cases. The recording time ranged between 1

Neurointensive Care Monitoring for Severe Traumatic Brain Injury

“…In between P2 and P3, there is dicrotic notch which is also thought arising from the effect of aortic valves closure. In 1965, Lundberg described three time-dependent patterns of pressure waves in patients with raised ICP (Lundberg et al, 1965). Lundberg A or plateau waves are 50 -100 mmHg high and last for 5 to 20 minutes.…”

Biomarkers in Neurocritical Care

“…This may result from global or focal increased intracranial pressure. The correlation between elevated ICP and poor outcomes in severe TBI is well-described [38][39][40], and comatose patients with a glasgow coma score (GCS) <9 are at highest risk for developing high ICP [41]. Although the placement of an intracranial pressure monitor in severe TBI is nearly universal, ICP-and CPP-targeted therapy has not formally been shown to improve outcomes in randomized controlled trials [42,43].…”

Unraveling the complexities of invasive multimodality neuromonitoring

“…First, the ability to continuously record intracranial ventricular fluid pressure 19,34 established the feasibility of real-time bedside monitoring of intracranial physiology. Second, indicator dilution techniques enabled accurate measurements of cerebral perfusion in humans and demonstrated that elevated ICP leads to reduced CBF.…”