Intracranial Pressure Monitoring via External Ventricular Drain: Are We Waiting Long Enough Before Recording the Real Value?
Intracranial Pressure Monitoring via External Ventricular Drain: Are We Waiting Long Enough Before Recording the Real Value?
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通过心室外引流监测颅内压：我们在记录真实值之前等待的时间是否足够长？
DOI：
10.1097/jnn.0000000000000487
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Hu,Xiao
中科院分区：
文献类型：
--
作者：
Liu,Xiuyun;Griffith,Margaret;Jang,HannahJ;Ko,Nerissa;Pelter,MicheleM;Abba,Jacob;Vuong,Maximilian;Tran,Nate;Bushman,Kelly;Hu,Xiao
背景脑室外引流（EVD）是监测颅内压（ICP）和引流蛛网膜下腔出血患者脑脊液（CSF）的标准方法。记录准确的ICP值对于评估大脑状态非常重要，这将需要EVD系统适当水平并关闭CSF引流足够长的时间。建议在记录真正的ICP之前至少需要5分钟的EVD关闭时间;然而，记录ICP没有公认的标准。为了深入了解如何以及间歇性EVD夹紧程序进行ICP文件，我们进行了一项回顾性分析，通过EVD从107例蛛网膜下腔出血的ICP记录。METHODS EVD是保持开放的连续CSF引流，然后间歇性关闭ICP文件。对于每次EVD闭合，研究了平均ICP、ICP标准差、EVD闭合持续时间和2次相邻EVD闭合之间的时间间隔。计算每例患者的EVD闭合总数。我们开发了一种算法来评估在EVD重新开放引流之前ICP是否达到新的平衡。107例患者共进行了32755次EVD闭合，其中65.9%的EVD闭合持续时间小于1 min，仅16.3%的EVD闭合持续时间超过5 min。每次EVD闭合的中位持续时间为25秒（四分位距，10.2秒至2.33分钟）。只有22.9%的EVD关闭达到ICP平衡EVD reopening.CONCLUSIONA标准的指导方针和适当的培训是必要的床旁护士，和一个潜在的工具，可以使ICP趋势在一个适当的规模在床旁将有助于临床医生正确的文件ICP。
BACKGROUNDExternal ventricular drain (EVD) is a standard approach for both monitoring intracranial pressure (ICP) and draining cerebrospinal fluid (CSF) for patients with subarachnoid hemorrhage. Documenting an accurate ICP value is important to assess the status of the brain, which would require the EVD system to be leveled properly and closed to CSF drainage for an adequate period. It is suggested that a minimum period of 5-minute EVD closure is needed before documenting a true ICP; however, there is no commonly agreed upon standard for documenting ICP. To obtain an insight into how well the intermittent EVD clamping procedure is performed for ICP documentation, we conducted a retrospective analysis of ICP recordings obtained through EVD from 107 patients with subarachnoid hemorrhage.METHODSThe EVD was kept open for continuous CSF drainage and then intermittently closed for ICP documentation. For each EVD closure, mean ICP, standard deviation of ICP, duration of EVD closure, and time interval between 2 adjacent EVD closures were studied. The total number of EVD closures was calculated for each patient. We developed an algorithm to evaluate whether ICP reached a new equilibrium before the EVD was reopened to drainage. The percentage of EVD closures that reach the equilibrium was calculated.RESULTSThe 107 patients had 32 755 EVD closures in total, among which 65.9% instances lasted less than 1 minute and only 16.3% of all the EVD closure episodes lasted longer than 5 minutes. The median duration of each EVD closure was 25 seconds (interquartile range, 10.2 seconds to 2.33 minutes). Only 22.9% of the EVD closures reached ICP equilibrium before EVD reopening.CONCLUSIONA standard guideline and proper training are needed for bedside nurses, and a potential tool that can render ICP trend at a proper scale at bedside would help clinicians correctly document ICP.
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