CPP MANAGEMENT--INFORMATION FEEDBACK & NURSING

本建议的目的是在最佳的背景下评估 脑血管动力学的医疗管理， 脑灌注压（CPP）信息床边系统 反馈CPP的护理即时管理， 治疗与患者功能结果的关系 出院3和6个月。 预防或减少继发性脑损伤 损伤是患者重症监护管理的关键组成部分 各种各样的大脑侮辱。 当前临床管理 强调将COO保持在70 mm Hg或以上，以最大限度地减少 二次伤害 然而，由于临床上人体工程学较差， 监测显示，很可能是短期事件减少 在必要的病人护理过程中， 重新定位、抽吸和其他常规治疗活动。 鉴于神经元灌注在防止继发性脑缺血中的关键作用， 伤害，超越了原来的大脑侮辱，提炼 护士随时观察和管理CPP的能力 基础可能允许短期和长期患者的可测量改善 功能性成果。 提供视觉效果的计算机界面 有关自愿退休计划的资料将随机分配至 3个用于闭合性头部损伤患者的重症监护室 或蛛网膜下腔出血，其中ICP监测器和动脉导管 按小学分类的医疗管理 诊断（CHI或SAH）和严重程度。 连续数据将 从150名患者中收集，其中150名患者未使用接口 CPP监测期间的监测，主要假设 正在测试的是，急性发作后6个月的格拉斯哥结局评分（GOS） 护理出院将显着更好地在那些监测与 连续CPP显示。 次要终点为出院时GOS 出院后3个月，功能独立性测量（Functional Independence Measure，FMD） 出院、3个月和6个月时的评分，过程终点为 在医院监测期间，CPP低于70 mm Hg的百分比，以及 监测期间脑氧饱和度下降率

The aim of this proposal is to evaluate, in the context of optimal medical management of cerebrovascular dynamics, the impact of a bedside system of cerebral perfusion pressure (CPP) information feedback on nursing moment-to-moment management of CPP, and the relationship of that management to patient functional outcome at discharge 3 and 6 months. Prevention or reduction of secondary brain injury is a key component of critical care management for patients with a variety of brain insults. Current clinical management emphasizes maintaining COO at or above 70mm Hg to minimize such secondary injury. However, due to poor ergonomics in clinical monitoring displays, it is likely that short episodes of decreased CPP are missed by attending nurses in the course of necessary patient repositioning, suctioning, and other routine therapeutic activities. Given the crucial role of neuronal perfusion in preventing secondary injury, beyond that of the original brain insult, refining the nurse~s ability to visualize and manage CPP on a moment-to-moment basis may allow measurable improvement in short and long-term patient functional outcome. Computer interfaces that provide visual information about CPP will be randomly allocated to beds in each of the 3 intensive care units used for patients with closed head injury or subarachnoid hemorrhage, in whom ICP monitors and arterial lines have been placed for medical management, stratified by primary diagnosis (CHI or SAH) and severity. Continuous data will be collected from 150 patients with 150 patients without the interface monitor for the duration of CPP monitoring, The primary hypothesis being tested are that Glasgow Outcome Score (GOS) 6 months post acute care discharge will be significantly better in those monitored with the continuous CPP display. Secondary endpoints are GOS at discharge and 3 months post discharge, Functional Independence Measure (FIM) score at discharge, 3 and 6 months, Process endpoint is the percentage of CPP below 70mm Hg during hospital monitoring, and the rate of cerebral oxygen desaturation during monitoring