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Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: A prospective clinical study
Kerwin, AJ; Croce, MA; Timmons, SD; Maxwell, RA; Malhotra, AK; Fabian, TC;
Univ Tennessee, Presley Reg Trauma Ctr, Dept Surg, Memphis, TN USA Univ Tennessee Memphis TN USA Reg Trauma Ctr, Dept Surg, Memphis, TN USA Univ Tennessee, Dept Neurosurg, Memphis, TN USA Univ Tennessee Memphis TNUSA Tennessee, Dept Neurosurg, Memphis, TN USA
Titolo Testata:
fascicolo: 5, volume: 48, anno: 2000,
pagine: 878 - 882
head injury; cerebral perfusion pressure; intracranial pressure; fiberoptic bronchoscopy;
Tipo documento:
Settore Disciplinare:
Clinical Medicine
Indirizzi per estratti:
Indirizzo: Kerwin, AJ Univ S Carolina, Sch Med, Dept Surg, 2 Med Pk,Suite 402, Columbia, SC 29203 USA Univ S Carolina 2 Med Pk,Suite 402 Columbia SC USA 29203 03 USA
A.J. Kerwin et al., "Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: A prospective clinical study", J TRAUMA, 48(5), 2000, pp. 878-882


Background: Fiberoptic bronchoscopy (FB) plays an important role in makingthe diagnosis of nosocomial pneumonia and resolving lobar atelectasis in critically injured trauma patients. It has been shown to be a safe procedurewith only occasional complications. However, in patients with head injuries, FB can lead to intracranial hypertension, Sustained increases in intracranial pressure (ICP) leads to poor outcome in these patients. Because of this, a prospective study was done not only to assess the effect of FB on ICPand cerebral perfusion pressure (CPP) in patients with brain injuries, butalso to identify a regimen of sedation and anesthesia that could prevent significant increases in ICP during FB. Methods: Twenty-six FB were performed in 23 patients with ICP monitors or ICP monitors and ventriculostomy drains in place for Glasgow Coma Scale score < 8 or management of postcraniotomy trauma. FB was performed to aid in the diagnosis of nosocomial pneumonia or to aid in resolving lobar atelectasis. Before FB, all patients received a standard anesthetic regimen consisting of vecuronium (10 mg), morphine sulfate (4 mg!, and midazolam (2.5 mg), Patients with diminished cranial compliance, defined as ICP > 10 mm Hg, also received a nebulizer treatment of 3 mL of 4% lidocaine before FB, All patients were preoxygenated,with F-IO2 = 1.0 for 10 minutes, Intracranial pressure, mean arterial pressure, and CPP were monitored continuously throughout the procedure. These same variables were also recorded at baseline and at2-minute intervals during the procedure. The time to return to baseline ICP was also recorded. Results: The mean ICP at baseline (immediately before FB) was 12.6 mm Hg, After introduction of the bronchoscope, the ICP rapidly increased in 21 procedures (81%) and the mean highest ICP was 38.0 mm Hg, There was also a concomitant increase in mean arterial pressure such that there was no substantial change in CPP, The mean lowest CPP was 73.1 mm Hg. The average time forreturn of ICP to baseline was 13.9 minutes. In the subgroup of patients with ICP > 10, attempting to blunt the tracheal stimulation by anesthetizing the trachea with 4% nebulized lidocaine did not seem to he successful. The mean highest ICP in this subgroup was 41.8 mm Hg. The CPP changed in a similar manner, as the mean lowest CPP was 74.0 mm Hg, The mean time to return to baseline was 12.5 minutes. No patient had acute neurologic deteriorationsecondary to EB. Conclusions: Although FB is an important procedure in the pulmonary care of head injured patients, it produces substantial, but transient, increases in ICP and should be used with caution in patients with diminished cranial compliance. Sedation, analgesia, paralysis, and topical tracheal anesthesiadid not completely prevent the rise in ICP, Although no acute deterioration in condition occurred, secondary brain injury caused by localized cerebral ischemia is certainly possible, Because of the substantial increases in ICP, herniation may be precipitated in an occasional patient. Further study is needed to identify a regimen that will confer protection.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/09/20 alle ore 04:07:59