CPP MANAGEMENT--INFORMATION FEEDBACK & NURSING

这项建议的目的是在最佳方案的背景下评价 医疗管理对脑血管动力学的影响 床边脑灌注压(CPP)信息系统 对CPP护理时点管理的反馈，以及 这一管理与患者功能预后的关系 出院3个月和6个月。预防或减少继发性脑损伤 伤害是危重病人护理管理的关键组成部分 带着各种各样的大脑侮辱。当前的临床管理 强调将首席运营官保持在70毫米汞或以上，以将这种情况降至最低 继发性损伤。然而，由于临床上人体工效学较差， 监测显示，很可能短发作次数减少 护理人员在必要病人的救治过程中错过CPP 重新定位、抽吸和其他常规治疗活动。 鉴于神经元灌流在预防继发性脑损伤中的关键作用 伤害，超越了最初的大脑侮辱，提炼了 护士~S能够随时可视化和管理CPP 基础可能允许短期和长期患者的可测量改善 功能结果。提供可视化的计算机界面 关于CPP的信息将随机分配到每个 闭合性颅脑损伤患者使用的3个重症监护室 或蛛网膜下腔出血，其中的颅内压监测和动脉导管 已被安排进行医疗管理，按初级医院分层 诊断(CHI或SAH)和严重程度。连续数据将是 收集自150名患者，其中150名患者没有接口 监测CPP监测的持续时间，主要假设 正在接受测试的是急性发作后6个月格拉斯哥预后评分(GOS) 接受监测的患者的护理出院情况将显著改善 连续的CPP显示。次要端点是出院时的GOS 出院后3个月进行功能独立性测评(FIM) 出院时、3个月和6个月的得分，流程终点为 在医院监测期间CPP低于70 mm Hg的百分比，以及 监测中的脑氧减饱和率

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