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创伤性脑损伤中的肺损伤风险通过最佳脑输液压力导向治疗来管理
Celeste Dias1,2, Alexandre de Castro1, Rita Gaio3,4
1Faculty of Medicine, University of Porto, Porto, Portugal.
概括
对创伤性脑损伤 (TBI) 的最佳CPP指导治疗似乎是安全的,减少了二次肺损伤风险. 这种方法平衡了脑部保护与系统性并发症,改善了患者的治疗结果.
科学领域:
- 神经临界护理是指神经临界护理.
- 密集护理医学是密集护理的医学.
- 创伤学 创伤学 创伤学
背景情况:
- 创伤性脑损伤 (TBI) 管理需要平衡二次脑损伤预防与急性呼吸困扰综合征 (ARDS) 等系统性并发症.
- 对TBI的治疗决策,如液体限制和高PEEP,可能会对神经结果产生负面影响.
- 保持最佳的脑 perfusion 压力 (CPP) 是至关重要的,因为低的 CPP 和过高的 CPP 都会导致不良结果.
研究的目的:
- 评估严重TBI患者个性化最佳CPP (CPPopt) 引导治疗的安全性.
- 评估CPCPopt引导治疗与二次肺损伤风险之间的关联.
- 确定CPCPopt引导治疗对患者结果的影响.
主要方法:
- 用压力反应指数 (PRx) 管理CPCPopt指导治疗的92名严重TBI患者的回顾性分析.
- 收集的数据包括前10天的血液气体,通风和大脑变量.
- 使用线性混合效应回归模型来分析时间变化.
主要成果:
- 该研究包括92名患者 (86%是男性,平均年龄为53岁),其中49%呈现多重创伤.
- 平均CPP为86±7mmHg,CPP-CPPopt为-2.8±10.2mmHg,PRx为0.03±0.19. 平均CPP为86±7mmHg,CPP-CPPopt为-2.8±10.2mmHg,PRx为0.03±0.19. 平均CPP为0.03±0.19. 平均CPP为0.03±0.19mmHg,CPP-CPPopt是0.03±0.2mmHg,CPP是0.03±0.19mmHg,CPP是0.03±0.19mmHg.
- 没有观察到CPP或CPPopt对PaO2/FiO2比率有显著影响,但PRx和驱动压力与PFratio有负相关性. 在结果和差异CPP-CPPopt.之间发现了显著的积极关联.
结论:
- 在严重的TBI患者中,CPPopt引导的治疗与更好的结果有关.
- 这种治疗策略似乎对二次肺损伤的发展是安全的.
- 个性化CPP管理可能是改善TBI神经和系统结果的关键因素.
相关概念视频
Traumatic Brain Injury l: Introduction
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Increased Intracranial Pressure l: Introduction
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Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
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