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Titolo:
Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage
Autore:
Munch, EC; Bauhuf, C; Horn, P; Roth, HR; Schmiedek, P; Vajkoczy, P;
Indirizzi:
Univ Heidelberg, Fac Clin Med Mannheim, Dept Anesthesiol & Crit Care Med, D-68167 Mannheim, Germany Univ Heidelberg Mannheim Germany D-68167 Med, D-68167 Mannheim, Germany Univ Heidelberg, Fac Clin Med Mannheim, Dept Neurosurg, D-68167 Mannheim, Germany Univ Heidelberg Mannheim Germany D-68167 surg, D-68167 Mannheim, Germany
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 5, volume: 29, anno: 2001,
pagine: 976 - 981
SICI:
0090-3493(200105)29:5<976:TOMIHB>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
SEVERE HEAD-INJURY; PRESSURE; MANAGEMENT;
Keywords:
adults; brain injury; cerebral edema; herniation; intracranial hypertension; lumbar drainage; outcome; subarachnoid hemorrhage;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
19
Recensione:
Indirizzi per estratti:
Indirizzo: Munch, EC Univ Heidelberg, Fac Clin Med Mannheim, Dept Anesthesiol & Crit Care Med, Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany Univ Heidelberg Theodor Kutzer Ufer 1-3 Mannheim Germany D-68167
Citazione:
E.C. Munch et al., "Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage", CRIT CARE M, 29(5), 2001, pp. 976-981

Abstract

Objectives: To evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension. Design: Prospective, pre- vs, postintervention study. Setting: Surgical intensive care unit of a university hospital. Patients: Twenty-three patients with severe traumatic brain injury or delayed ischemia after subarachnoid hemorrhage with intracranial hypertension refractory to aggressive treatment, including repeated applications of tromethamine, hypertonic saline solution, barbiturate coma, and decompressive craniectomy, Patients were considered for controlled lumbar cerebrospinal fluid drainage if basal cisterns on computerized tomography scan were discernible. Interventions: After institution of a lumbar drain, cerebrospinal fluid was gradually aspirated, and then, continuous cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and pupillary status. Measurements and Main Results: ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. The neurologic outcome of the patients was assessed according to the Glasgow Outcome Scale 6 months after injury. As a result of lumbar cerebrospinal fluid drainage, all patients demonstrated an immediate and lasting decrease of ICP and a concomitant increase of cerebral perfusion pressure. Two patients temporarily showed a unilateral fixed and dilated pupil 6 and 8 hrs after onset of lumbar cerebrospinal fluid drainage, respectively. Ten patients showed a favorable outcome, four patients survived with a severe permanent neurologic deficit, one patient remained in apersistent vegetative state, and eight patients died. Conclusions: Controlled lumbar cerebrospinal fluid drainage significantly reduces refractory intracranial hypertension. The danger of transtentorial or tonsillar herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/12/20 alle ore 00:30:07