Changes in Blood Pressure and Heart Rate during Decompressive Craniectomy

Area of Science:

• Neurosurgery
• Intensive Care Medicine
• Neurology

Background:

• Rapid increases in intracranial pressure (ICP) can lead to Cushing's phenomenon, characterized by hypertension, bradycardia, and apnea.
• Decompressive craniectomy (DC) is a surgical procedure to reduce elevated ICP.
• Changes in mean arterial blood pressure (mABP) and heart rate (HR) during DC may reflect cerebrovascular autoregulation and vasomotor reflex integrity.

Purpose of the Study:

• To investigate the relationship between changes in ICP, mABP, and HR during DC.
• To determine if HR changes after DC correlate with preserved autoregulation and vasomotor reflex.
• To assess the prognostic value of HR changes following DC for clinical outcomes.

Main Methods:

• A prospective study involving 82 patients undergoing DC for traumatic brain injury, hypertensive intracerebral hematoma, or major infarction.
• Simultaneous monitoring of ICP, mABP, and HR at one-minute intervals before, during, and after DC.
• Statistical analysis to evaluate changes in physiological parameters and their correlation with clinical outcomes.

Main Results:

• DC resulted in a significant decrease in ICP (from 38.1±16.3 mmHg to 9.5±14.2 mmHg) and mABP (from 86.4±14.5 mmHg to 72.5±11.4 mmHg).
• Overall HR did not significantly change post-DC (100.1±19.7 to 99.7±18.2 rate/min).
• An increase in HR after DC correlated with favorable outcomes (p<0.001), while decreased or unchanged HR was associated with increased mortality (p=0.032).

Conclusions:

• Decompressive craniectomy effectively reduces intracranial pressure in all patients.
• Heart rate dynamics following DC serve as an indicator of preserved autoregulation and vasomotor reflex.
• Increased heart rate post-DC is associated with improved clinical outcomes, highlighting its prognostic significance.