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Acta Neurochirurgica

Published in:

01-12-2008 | Clinical Article

Analysis of intracranial pressure changes during early versus late percutaneous tracheostomy in a neuro-intensive care unit

Authors: Hasan Kocaeli, Ender Korfalı, Özgür Taşkapılıoğlu, Tekin Özcan

Published in: Acta Neurochirurgica | Issue 12/2008

Abstract

Background

We aimed to investigate intracranial pressure (ICP) changes during early versus late bedside percutaneous tracheostomy (PT) in a neuro-intensive care unit (NICU).

Methods

This study included 30 patients admitted to our NICU for head trauma, subarachnoid haemorrhage, intracerebral haematoma or brain tumour with a Glasgow Coma Score (GCS) less than 8. These patients also underwent ICP monitoring. Bedside PT was performed either early (within 7 days of ventilation) or late (after 7 days of ventilation) via the Griggs system. In all patients; ICP, systemic blood pressure, heart rate, oxygen saturation (Sat O₂) and arterial blood gases were recorded 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure.

Findings

Thirty patients, 18 male and 12 female, with various intracranial pathologies between ages 18 and 78 (mean 38.7 ± 20) were identified. The admission GCS ranged between 4 and 11 (median 7). Physiological variables did not differ significantly between the two groups. In the early group, ICP values measured 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure were 15.1 ± 5.2, 22 ± 10.1, 28.4 ± 13.7, 17.3 ± 7.1, 13.8 ± 5.0 mmHg, respectively. In the late group, these values were 14.2 ± 4.5, 17.2 ± 5.5, 21.5 ± 8.0, 15.1 ± 5.3 and 12.4 ± 4.1 mmHg. There was no significant difference between the early or late groups in terms of ICP increases during these predetermined 5 time points.

Conclusions

In patients with decreased intracranial compliance, a relatively minimally invasive procedure such as PT may lead to significant increases in ICP. The timing of PT does not seem to influence ICP, mortality, pneumonia or early complications. During the PT procedure, ICP should be closely monitored and preventive strategies should be instituted in an attempt to prevent secondary insult to an already severely injured brain.

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Title: Analysis of intracranial pressure changes during early versus late percutaneous tracheostomy in a neuro-intensive care unit
Authors: Hasan Kocaeli
Ender Korfalı
Özgür Taşkapılıoğlu
Tekin Özcan
Publication date: 01-12-2008
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 12/2008
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-008-0153-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Analysis of intracranial pressure changes during early versus late percutaneous tracheostomy in a neuro-intensive care unit

Abstract

Background

Methods

Findings

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Findings

Conclusions

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