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Bedside percutaneous tracheostomy (PT) is very commonly used for patients who require prolonged mechanical ventilation. The effect of tracheostomy on intracranial pressure (ICP) is currently a subject of controversy. The aim of our study is to clarify the relation between PT and its effect on ICP and cerebral perfusion pressure.
38 patients on our intensive care unit were included prospectively in an observational study. We examined mean values of HF, SpO(2), ICP, CPP, and MAP for changes over five different phases of the procedure using paired Mann-Whitney U tests. A p value of <0.05 was considered significant. p values were Bonferroni corrected for multiple testing.
PT was performed on 38 patients (f = 19, m = 19; mean = 56 years). Median ICP before intervention was 9 mmHg. During positioning of the patient, ICP had risen to 14, during bronchoscopy to 16, and during tracheostomy to 18 mmHg, all being significantly higher than baseline level. Monitoring of MAP showed a significant increase to 101 mmHg only during tracheostomy. SpO(2) and HF did not show any significant changes. Mean duration of positioning, bronchoscopy and tracheostomy was 19, 10, and 17 min. 8 patients received osmotherapy due to a rise of ICP of more than 30 mmHg.
PT only leads to a significant rise of ICP during the procedure. Nevertheless, therapy of ICP is necessary in some patients. From our point of view, therefore, tracheostomy should only be performed under continuous monitoring of ICP and CPP in patients with severe cerebral dysfunctions and critically elevated ICP.
Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany, firstname.lastname@example.org.
This article was published in the following journal.
Name: Neurocritical care
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The pressure within the CARDIAC ATRIUM. It can be measured directly by using a pressure catheter (see HEART CATHETERIZATION). It can be also estimated using various imaging techniques or other pressure readings such as PULMONARY CAPILLARY WEDGE PRESSURE (an estimate of left atrial pressure) and CENTRAL VENOUS PRESSURE (an estimate of right atrial pressure).
Body ventilators that assist ventilation by applying intermittent subatmospheric pressure around the thorax, abdomen, or airway and periodically expand the chest wall and inflate the lungs. They are relatively simple to operate and do not require tracheostomy. These devices include the tank ventilators ("iron lung"), Portalung, Pneumowrap, and chest cuirass ("tortoise shell").
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