COMPARISON OF CSF DRAINAGE PROTOCOLS IN ICP MANAGEMENT

ICP 管理中 CSF 引流方案的比较

• 批准号: 2257364
• 负责人: Mary E. Kerr
• 金额: $ 27.75万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-08-01 至 1998-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2257364
• 关键词: blood pressure; blood volume; brain circulation; electroencephalography; head /neck injury; heart rate; hemodynamics; human subject; intracranial pressure; neurophysiology; nursing intervention; oxygen consumption; patient care management; ultrasound blood flow measurement

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.

颅内高压是造成头部继发性损伤的主要原因 受伤患者和针对患者的主要预后指标 死亡和功能结果不佳的风险。脑脊液 （脑脊液）引流是一种针对颅内高压的医疗干预措施 护士对头部外伤患者发起和施加的压力（ICP） 独立决定，包括脑脊液的时间、频率和数量 引流。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 降低颅内压并改善头部受伤患者的脑灌注。 这项研究是研究者在一项广泛计划中的第二项研究 确定护理干预对头部受伤患者的效果 关于大脑功能。本研究将比较脑血管 头部受伤患者对三种脑脊液引流方案的反应 护理人员可以使用传统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） 脑脊液引流可改善 ICP 和脑灌注 [根据脑 灌注压（CPP）、脑血流速度（Vmac）和氧 颈静脉球张力(PjO2]?2)变化有差异吗 ICP 和脑灌注受 CSF 引流量影响（1,2 和 3 毫升）？ 3) 血流动力学反应是否存在差异[系统 CSF 之前和之后的动脉压 (SAP) 和心率 (HR)] 引流？本研究的次要目的是事后比较 分析临床连续监测的传统方法 评估脑血管反应（ICP 和 CPP）的区域 先进的神经生理学方法（Vmac 和 PjO2）并识别任何 年龄、脑脊液总量和脑脊液引流频率的调节作用 在开始脑脊液引流方案之前，基线动脉碳 二氧化碳浓度、药物、温度和头部受伤类型 脑脊液引流的功效。 这种受试者内重复测量设计将随机化 3 个方案 60 名头部受伤患者的脑脊液引流。自变量是 脑脊液引流（1 mL、2 mL、3 mL）。同时实时数据 生理参数（SAP、ICP、HR、SpO2、Vmac、P/ET CO2）是 在 CSF 之前、期间和之后连续采集和记录 排水协议。 SAP 和 ICP 使用压力传感器测量 连接到古尔德放大器并根据汞柱进行校准。 HR 通过将 EKG 肢体导联连接到 Gould 放大器来收集。电压 使用连接到古尔德放大器的经颅多普勒进行测量。 PjO2 和 SpO2 通过血气进行验证。放大器传输模拟信号 将数据传输至计算机化的古尔德数据采集和系统分析程序 用于模拟到数字的转换和分析。多元和 重复测量方差分析将确定最有效的 降低ICP、保留脑灌注的脑脊液引流方法。