The Use of Continuous Cerebral Blood Flow Monitoring after Severe Head Injury

Czech version

Authors: A. Mrlian ¹; M. Smrčka ¹; M. Duba ¹; R. Gál ²; P. Ševčík ²
Authors‘ workplace: LF MU a FN Brno Neurochirurgická klinika ¹; LF MU a FN Brno Klinika anesteziologie, resuscitace a intenzivní medicíny ²
Published in: Cesk Slov Neurol N 2010; 73/106(6): 711-715
Category: Short Communication

Overview

Introduction:
Intensive treatment of patients in the early post-traumatic phase after severe brain injury is fundamental to the outcome of the treatment. Severe brain injuries are burdened with high mortality. According to the results of some studies, 40% to 60% of the treatments of such patients end in unsatisfactory fashion. Comprehensive invasive monitoring may enable more detailed evaluation of the current status of patients and help the initiation of adequate therapy in good time. Material and methods: A pilot study has employed a unique method for direct continuous measurement of cerebral blood flow (CBF). We compared the benefits of this method with other, established methods. A total of 5 patients were analyzed after severe brain injury. Immediately upon presentation, invasive continuous monitoring of intracranial pressure, cerebral perfusion pressure, blood flow to brain tissue and tissue oxygen levels was begun. Patients were treated conservatively or surgically. We analyzed the influence of different monitoring modalities within the group and the combinations of treatment strategy for these patients, with particular reference to the benefits of direct continuous measurement of CBF. Results: All the parameters studied correlated with one another, a rise in ICP was followed by a decrease of CPP, cerebral perfusion (CBF) and tissue oxygen levels (p <0.01). The parameters monitored responded to changes of therapy and deviations in parameters indicated neurosurgical intervention. Conclusion: Comprehensive monitoring of patients after severe brain injury improves intensive treatment in these patients and provides a more comprehensive picture of the several processes running in the damaged brain tissue. Direct measurement of CBF helps to assess the patient‘s condition and, in combination with other methods, could accelerate the selection of appropriate therapeutic modalities, which might ultimately improve the overall outcome of treatment.

Key words:
severe brain injury – multimodal monitoring – cerebral blood flow

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