Intracranial pressure changes in patients with head trauma during haemodialysis

Bertrand, Y.; A, Hermant; Mahieu, Paul; Roels, J.

doi:10.1007/bf01692550

Cited by 47 publications

(16 citation statements)

References 7 publications

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“…Increased ICP is frequently seen shortly after initiation of HD and prior to significant changes in serum osmolality or pH. These early changes are frequently preceded or accompanied by hypotension, decreasing CPP, and cerebral blood flow (CBF) [6]. This may lead to cerebrovascular vasodilatation and increased ICP.…”

Section: Discussionmentioning

confidence: 96%

“…Conventional IHD has been shown to exacerbate cerebral edema, increase intracranial pressure (ICP), and is associated with more hypotensive episodes and arrhythmias than CRRT [3][4][5][6]. In theory, CRRT may be beneficial in patients with intracranial hypertension (IH) due to its ability to adjust intravascular volume, remove water, solutes, and inflammatory mediators [7,8].…”

Section: Introductionmentioning

confidence: 98%

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Continuous Renal Replacement Therapy for Refractory Intracranial Hypertension

et al. 2009

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 98%

Continuous Renal Replacement Therapy for Refractory Intracranial Hypertension

et al. 2009

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“…The use of a modified dialysate sodium concentration has been previously reported for the management of dysnatremias. 30,31 These changes may occur within the first hour of treatment, before any major changes in plasma osmolality have occurred. This approach has three major drawbacks: significant financial cost of CVVH compared to the much less expensive ol-CVVHD-RCA, an additional workload imposed on the pharmacy personnel who perform the mixing, and the risk of contamination and errors during the injection of HS into the fluid bags.…”

Section: Discussionmentioning

confidence: 99%

High sodium continuous veno‐venous hemodialysis with regional citrate anticoagulation and online dialysate generation in patients with acute liver failure and cerebral edema

Hamdi

Yessayan

Yee

et al. 2017

Hemodialysis International

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We describe a novel approach for delivering continuous osmotherapy to patients with acute liver failure, renal failure, and cerebral edema. In comparison to standard therapy, the described modality enables precise titration of serum sodium without undesirable fluctuations in extracellular fluid volume. A particular advantage is zero delivery of citrate to this vulnerable group of patients with acute liver failure.

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“…There was a similar degree of P bt O 2 responsiveness to CPP compared to while on HD ( figure 1D). In addition, ORx was [2][3][4][5] Though the exact mechanism remains unclear, several theories, including the reverse urea effect, increase in idiogenic osmolar products, or a paradoxical intracellular acidosis, exist. [2][3][4] Our case shows a close relationship between initiation of HD and surges of ICP together with a decline in P bt O 2 .…”

Section: Oystermentioning

confidence: 99%

Pearls & Oy-sters: The effects of renal replacement therapy on cerebral autoregulation

Choi

Gilmore

et al. 2012

Neurology

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PEARLS• Hemodialysis (HD) has been associated with increases in intracranial pressure (ICP). Osmotic shifts occurring during HD are thought to be associated with the development of this phenomenon.• In comatose patients with acute brain injury, an elevation of ICP during HD may be associated with worse cerebral autoregulation. Continuous veno-venous hemofiltration (CVVH) may be a safer alternative in these patients. OYSTER• HD may increase ICP; therefore, caution should be exercised when HD is needed in patients with acute brain injury.CASE REPORT A 59-year-old man with hypertension, type 1 diabetes, and end-stage renal disease on HD presented after head trauma from a fall while walking. Initial neurologic examination showed agitated confusion (E4 M5 V5) and a noncontrast head CT showed a nondepressed linear skull fracture in the right temporal bone with a small amount of subarachnoid hemorrhage in the left superior frontal convexity. On arrival to the neurointensive care unit (NICU), his mental status deteriorated (E1 M4 VT) and a follow-up noncontrast head CT revealed a new intracerebral hemorrhage (ICH) in the left temporal lobe (4.3 cm ϫ 2.2 cm ϫ 3.5 cm) with surrounding edema ( figure 1A). The patient's family opted for maximal medical management. Multimodality monitoring (MMM) including an intracranial pressure (ICP) monitor (Camino, Integra Lifesciences) and a brain oxygen monitor (Licox, Integra Lifesciences) was placed in the left frontal lobe, close to the perihematomal region. HD was performed every other day via a pre-existing left groin arteriovenous fistula with a negative goal fluid balance of 2 L per each 3.5-hour session. Initially, MMM demonstrated a mildly elevated ICP (mean 18.9 Ϯ 7.4 mm Hg) over a wide range of mean arterial pressures (MAPs) (60 -120 mm Hg) and ICP increase was not directly proportional to MAP changes, suggesting intact autoregulation. Pressure reactivity index (PRx), a Pearson moving correlation coefficient between MAP and mean ICP, which is accepted as a surrogate for autoregulation status, was also stable at 0.18 Ϯ 0.05 (mean Ϯ SD), implying intact pressure autoregulation. Partial brain oxygen tension (P bt O 2 ) was directly proportional to the cerebral perfusion pressure (CPP) up to 80 mm Hg. Oxygen reactivity index, a moving correlation coefficient between P bt O 2 and CPP, was 0.19 Ϯ 0.11. The mean P bt O 2 value was 43.1 Ϯ 11.2 mm Hg. Over the initial 2 weeks, the ICP trended up, requiring hyperosmotic agents to maintain an ICP below 20 mm Hg. Glasgow Coma Scale score deteriorated to E1, M2, VT. Follow-up brain CT scan showed increased perihematomal vasogenic edema with aggravated midline shift (figure 2). On hospital day 16, while receiving his regularly scheduled HD, the ICP surged up to 38 mm Hg just after initiating HD and remained elevated during the entire session. ICP was directly dependent on MAP, suggesting a loss of autoregulation ( figure 1B). Additionally, PRx values were elevated more than 0.2, which also suggested autoregulatory failure (figure 1C). Mea...

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Intracranial pressure changes in patients with head trauma during haemodialysis

Cited by 47 publications

References 7 publications

Continuous Renal Replacement Therapy for Refractory Intracranial Hypertension

Continuous Renal Replacement Therapy for Refractory Intracranial Hypertension

High sodium continuous veno‐venous hemodialysis with regional citrate anticoagulation and online dialysate generation in patients with acute liver failure and cerebral edema

Pearls & Oy-sters: The effects of renal replacement therapy on cerebral autoregulation

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