Safety and Reliability of Bedside, Single Burr Hole Technique for Intracranial Multimodality Monitoring in Severe Traumatic Brain Injury
- 08.06.2018
- Original Article
Erschienen in:
- Verfasst von
- Brandon Foreman
- Laura B. Ngwenya
- Erica Stoddard
- Jason M. Hinzman
- Norberto Andaluz
- Jed A. Hartings
- Erschienen in
- Neurocritical Care | Ausgabe 3/2018
Abstract
Background
We aimed to provide a systematic description of our 2-year experience using a standardized bedside, single burr hole approach to intracranial multimodality monitoring (MMM) in patients with severe traumatic brain injury (sTBI), focusing on safety and probe reliability.
Methods
We performed this observational cohort study at a university-affiliated, Level I trauma center with dedicated 20-bed neuroscience intensive care unit. We included 43 consecutive sTBI patients who required MMM to guide clinical care based on institutional protocol and had a four-lumen bolt placed to measure intracranial pressure, brain tissue oxygen, regional cerebral blood flow, brain temperature, and intracranial electroencephalography.
Results
sTBI patients were aged 41.6 ± 17.5 years (mean ± SD) and 84% were men. MMM devices were placed at a median of 12.5 h (interquartile range [IQR] 9.0–21.4 h) after injury and in non-dominant frontal lobe in 72.1% of cases. Monitoring was conducted for a median of 97.1 h (IQR 46.9–124.6 h) per patient. While minor hemorrhage, pneumocephalus, or small bone chips were common, only one (2.4%) patient experienced significant hemorrhage related to device placement. Radiographically, device malpositioning was noted in 13.9% of patients. Inadvertent device discontinuation occurred for at least one device in 58% of patients and was significantly associated with the frequency of travel for procedures or imaging. Devices remained in place for > 80% of the total monitoring period and generated usable data > 50% of that time.
Conclusions
A standardized, bedside single burr hole approach to MMM was safe. Despite some probe-specific recording limitations, MMM provided real-time measurements of intracranial pressure, oxygenation, regional cerebral blood flow, brain temperature, and function.
Anzeige
- Titel
- Safety and Reliability of Bedside, Single Burr Hole Technique for Intracranial Multimodality Monitoring in Severe Traumatic Brain Injury
- Verfasst von
-
Brandon Foreman
Laura B. Ngwenya
Erica Stoddard
Jason M. Hinzman
Norberto Andaluz
Jed A. Hartings
- Publikationsdatum
- 08.06.2018
- Verlag
- Springer US
- Erschienen in
-
Neurocritical Care / Ausgabe 3/2018
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961 - DOI
- https://doi.org/10.1007/s12028-018-0551-7
Dieser Inhalt ist nur sichtbar, wenn du eingeloggt bist und die entsprechende Berechtigung hast.
Dieser Inhalt ist nur sichtbar, wenn du eingeloggt bist und die entsprechende Berechtigung hast.
