Dose Response to Cerebrospinal Fluid (CSF) Drainage on Cerebral Perfusion in Traumatic Brain Injured (TBI) Adults

2.50
Hdl Handle:
http://hdl.handle.net/10755/163742
Category:
Abstract
Type:
Presentation
Title:
Dose Response to Cerebrospinal Fluid (CSF) Drainage on Cerebral Perfusion in Traumatic Brain Injured (TBI) Adults
Author(s):
Weber, Barbara
Author Details:
Barbara Weber, MS/MSc, University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania, USA, email; bbwe/bbwc@pitt.edu
Abstract:
Purpose: Refractory intracranial hypertension remains a complication following TBI that has a devastating impact on outcomes. Removing CSF from a ventriculostomy is recommended as a first line treatment in decreasing the intracranial pressure (ICP). However, there is a paucity of research to guide this therapy. The purpose of this investigation was to determine the effect of three alternate volumes of CSF fluid removal via a ventriculostomy on ICP and indices of cerebral perfusion. Research Question: Is there a difference in the response of ICP and cerebral perfusion by the amount of CSF drained (1 mL, 2 mL, and 3 mL)? Methods: This study involved 58 severe head injured patients (Glasgow Coma Score < 8). ICP and other indices of cerebral perfusion [cerebral perfusion pressure (CPP), and cerebral blood flow velocity (BFV) of the middle cerebral artery] were measured using continuous bedside monitoring before, during and after CSF drainage. Subjects underwent three randomly ordered CSF drainage protocols that varied in the volume of CSF removed (1mL, 2 mL, and 3 mL) from the ventriculostomy for a total of 6 mL of CSF removed. Time averaged values of monitored physiologic variables were calculated in 1 minute blocks from baseline (B), up to 10 minutes post CSF drainage (P1-P10). Results: For ICP (see graph) and CPP, significant drainage amount and time were observed, yielding parallel, yet distinguishable, response profiles. The greatest change in mean CPP was for 3 mL removed, baseline CPP increased from 74.9 to 79.0 mmHg immediately after drainage and decreased to 77.6 mmHg at 10 minutes post drainage. There were no significant effects for BFV. Conclusions: There was a dose response by CSF volume removed with 3mL having the largest decrease in ICP and increase in CPP. However the changes were transient and of small magnitude. Other indices of cerebral perfusion did not show a measurable improvement during that period. Implications for practice: CSF drainage is a nurse-implemented intervention for elevated ICP in patients with head trauma. This research suggests that other methods to evoke the efficacy of this therapy need to be Investigated.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2001
Conference Name:
ENRS 13th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
Atlantic City, New Jersey, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleDose Response to Cerebrospinal Fluid (CSF) Drainage on Cerebral Perfusion in Traumatic Brain Injured (TBI) Adultsen_GB
dc.contributor.authorWeber, Barbaraen_US
dc.author.detailsBarbara Weber, MS/MSc, University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania, USA, email; bbwe/bbwc@pitt.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/163742-
dc.description.abstractPurpose: Refractory intracranial hypertension remains a complication following TBI that has a devastating impact on outcomes. Removing CSF from a ventriculostomy is recommended as a first line treatment in decreasing the intracranial pressure (ICP). However, there is a paucity of research to guide this therapy. The purpose of this investigation was to determine the effect of three alternate volumes of CSF fluid removal via a ventriculostomy on ICP and indices of cerebral perfusion. Research Question: Is there a difference in the response of ICP and cerebral perfusion by the amount of CSF drained (1 mL, 2 mL, and 3 mL)? Methods: This study involved 58 severe head injured patients (Glasgow Coma Score < 8). ICP and other indices of cerebral perfusion [cerebral perfusion pressure (CPP), and cerebral blood flow velocity (BFV) of the middle cerebral artery] were measured using continuous bedside monitoring before, during and after CSF drainage. Subjects underwent three randomly ordered CSF drainage protocols that varied in the volume of CSF removed (1mL, 2 mL, and 3 mL) from the ventriculostomy for a total of 6 mL of CSF removed. Time averaged values of monitored physiologic variables were calculated in 1 minute blocks from baseline (B), up to 10 minutes post CSF drainage (P1-P10). Results: For ICP (see graph) and CPP, significant drainage amount and time were observed, yielding parallel, yet distinguishable, response profiles. The greatest change in mean CPP was for 3 mL removed, baseline CPP increased from 74.9 to 79.0 mmHg immediately after drainage and decreased to 77.6 mmHg at 10 minutes post drainage. There were no significant effects for BFV. Conclusions: There was a dose response by CSF volume removed with 3mL having the largest decrease in ICP and increase in CPP. However the changes were transient and of small magnitude. Other indices of cerebral perfusion did not show a measurable improvement during that period. Implications for practice: CSF drainage is a nurse-implemented intervention for elevated ICP in patients with head trauma. This research suggests that other methods to evoke the efficacy of this therapy need to be Investigated.en_GB
dc.date.available2011-10-27T11:13:01Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:13:01Z-
dc.conference.date2001en_US
dc.conference.nameENRS 13th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationAtlantic City, New Jersey, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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