COMPARISON OF CSF DRAINAGE PROTOCOLS IN ICP MANAGEMENT

颅内压增高是导致颅脑继发性损伤的主要原因 受伤的病人和一个主要的预后指标， 死亡率和不良功能结局的风险。脑脊液 (CSF)引流是一种治疗颅内压升高的医疗干预措施， 脑外伤患者的颅内压（ICP），护士发起和使 独立决定，包括CSF的时间、频率和量 排水.由于缺乏经验数据，脑脊液引流的标准是 不一致，因此护士对此没有科学依据 实践本研究的目的是确定脑脊液引流是否 降低颅内压，改善脑灌注。 这项研究是研究者在一项广泛计划中的第二项研究， 目的探讨护理干预在颅脑损伤患者中的应用效果 对大脑功能的影响这项研究将比较脑血管 颅脑损伤患者对三种CSF引流方案的反应， 传统的和先进的神经生理学方法， 临床医生评估反应。研究问题是：1） CSF引流改善ICP和脑灌注[通过脑血流测量] 灌注压（CPP）、脑血流速度（Vmac）和氧 颈静脉球张力（PjO 2）？2）变化有区别吗 颅内压和脑灌注量与脑脊液引流量（1、2、3 mL）？以及3）血液动力学反应[系统]是否存在差异 CSF前后的动脉压（SAP）和心率（HR）] 排水系统？本研究的次要目的是比较 分析传统的连续监测方法在临床中的应用 脑血管反应（ICP和CPP）评估区域， 先进的神经生理学方法（Vmac和PjO 2），并确定任何 年龄、总容量和CSF引流频率的调节作用 在开始CSF引流方案之前，基线动脉碳 二氧化碳水平，药物，温度和头部受伤的类型 CSF引流的有效性。 这种受试者内重复测量设计将随机分配3个方案 60例颅脑损伤患者脑脊液引流的临床观察自变量为 脑脊液引流（1 mL、2 mL、3 mL）。同步真实的时间数据 生理参数（SAP、ICP、HR、SpO 2、Vmac、P/ET CO2） 在CSF之前、期间和之后连续采集和记录 引流方案。使用压力传感器测量SAP和ICP 连接到古尔德放大器上，用水银柱校准 通过将EKG肢体导联连接到Gould放大器来收集HR。VMAC 是用连接在古尔德放大器上的经颅多普勒测量的。 PjO 2和SpO 2通过血气进行验证。放大器传输模拟信号 数据输入计算机化的Gould数据采集和系统分析程序 用于模拟到数字转换和分析。多变量和 重复测量方差分析将确定最有效的 脑脊液引流术降低颅内压和维持脑灌注。

Intracranial hypertension is a primary cause of secondary injury in head injured patients and a major prognostic indicator targeting patients at risk for mortality and poor functional outcomes. Cerebrospinal fluid (CSF) drainage is a medical intervention for elevated intracranial pressure (ICP) in patients with head trauma that nurses initiate and make independent decisions including the timing, frequency, and amount of CSF drainage. With the lack of empirical data, standards for CSF drainage are inconsistent thus leaving nurses with no scientific rationale for this practice. The purpose of this study is to determine if CSF drainage decreases ICP and improves cerebral perfusion in head injured patients. This study is the investigator's second study within a broad plan to ascertain the effects of nursing interventions in head injured patients on cerebral function. This study will compare the cerebrovascular responses of head injured patients to three CSF drainage protocols using both traditional and advanced neurophysiologic methods available to nurse clinicians to evaluate the response. The research questions are: 1) Does CSF drainage improve ICP and cerebral perfusion [as measured by cerebral perfusion pressure (CPP), cerebral blood flow velocity (Vmac) and oxygen tension in the jugular bulb (PjO2]? 2)Is there a difference in the change in ICP and cerebral perfusion by the amount of CSF drainage (1,2 and 3 mL)? and 3) Is there a difference in the hemodynamic responses [system arterial pressure (SAP) and heart rate (HR)] before and after CSF drainage? Secondary aims of this study are to compare in post hoc analysis the traditional methods monitored continuously in the clinical area for assessment of cerebrovascular responses (ICP and CPP) with advanced neurophysiologic methods (Vmac and PjO2) and to identify any moderating effects from age, total volume and frequency of CSF drainage prior to initiation of CSF drainage protocol, baseline arterial carbon dioxide levels, medications, temperature and type of head injury on the efficacy of CSF drainage. This within-subject, repeated measures design will randomize 3 protocols of CSF drainage in 60 head injured patients. The independent variable is the CSF drainage (1 mL, 2 mL, 3 mL). Simultaneous real time data on physiologic parameters (SAP, ICP, HR, SpO2, Vmac, P/ET CO2) are continuously acquired and recorded before, during and following the CSF drainage protocols. SAP and ICP are measured using pressure transducers connected to Gould amplifiers and calibrated against a column of mercury. HR is collected by connecting EKG limb leads to a Gould amplifier. Vmac is measured using a transcranial doppler attached to a Gould amplifier. PjO2 and SpO2 are validated by blood gases. Amplifiers transmit analogue data to a computerized Gould Data Acquisition and System Analysis program for analogue to digital transformation and analysis. Multivariate and repeated measure analysis of variance will determine the most effective CSF drainage method for decreasing ICP and preserving cerebral perfusion.