Cerebral perfusion pressure during percutaneous dilatational tracheostomy

M. Gemma, S. Cozzi, A. Cipriani, M. R. Calvi, P. Garancini, G. Melloni, A. Carretta, P. Zannini

Research output: Contribution to journalArticle

Abstract

Objective: To assess the impact of the Ciaglia percutaneous dilatational tracheostomy (PDT) on intracranial pressure (ICP) in patients with severe brain injury. Design: Prospective observational study. Setting: Neurosurgical intensive car unit (nICU) of a university hospital. Subjects: Fifteen patients admitted to our nICU with severe brain injury, for whom PDT was scheduled provided that: i) prolonged nasotracheal intubation was anticipated because of the lack of adequate spontaneous ventilation and/or airway protection; ii) no haemostatic defect was apparent; iii) no lesions of the neck (traumatic, neoplastic, infectious, etc) were present; iv) extension of the neck was possible and did not cause ICP elevation; v) ICP was monitored via an intraparenchymal Camino device. Over the previous 24 hours cerebral perfusion pressure (CPP) was always ≤ 70 mmHg, ICP ≤ 20 mmHg and cerebrospinal fluid was not drained. Interventions: Ciaglia percutaneous dilatational tracheostomy. Measurements and main results: CPP was recorded at a 20/min sample rate during PDT. The occurrence of a CPP mean value <70 mmHg over 1 minute was defined as a cerebral hypoperfusion episode (CHE). CHEs occurred during PDT in eight patients - mean number of CHEs 11 (SD 6; range: 3-18). The mean longest CHE was eight (SD 5; range: 2-16) min. CHEs were due to ICP increases and not to falls in mean arterial pressure. The number of CHEs was associated with the baseline ICP quadratic term: r2 = 0.60 (p = 0.004) and r2 = 0.63 (p = 0.002) respectively, with an increasing number of CHEs for baseline ICP values above 10 mmHg. Conclusions: The Ciaglia PDT technique carries a potential risk for causing cerebral hypoperfusion in nICU patients. This risk can be substantially higher in patients with a higher baseline ICP, even if only those patients with 'safe' baseline ICP values <20 mmHg undergo PDT. Optimal management of PDT in neurosurgical patients should include CPP monitoring.

Original languageEnglish
Pages (from-to)77-80
Number of pages4
JournalClinical Intensive Care
Volume9
Issue number2
Publication statusPublished - 1998

Fingerprint

Cerebrovascular Circulation
Tracheostomy
Intracranial Pressure
Intracranial Hypertension
Brain Injuries
Neck
Hemostatics
Intubation
Observational Studies
Ventilation
Cerebrospinal Fluid
Arterial Pressure
Prospective Studies

Keywords

  • Cerebral perfusion pressure (CPP)
  • Intracranial pressure (ICP)
  • Neurosurgery
  • Neurosurgical intensive care unit (nICU)
  • Percutaneous dilatational tracheostomy (PDT)

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Gemma, M., Cozzi, S., Cipriani, A., Calvi, M. R., Garancini, P., Melloni, G., ... Zannini, P. (1998). Cerebral perfusion pressure during percutaneous dilatational tracheostomy. Clinical Intensive Care, 9(2), 77-80.

Cerebral perfusion pressure during percutaneous dilatational tracheostomy. / Gemma, M.; Cozzi, S.; Cipriani, A.; Calvi, M. R.; Garancini, P.; Melloni, G.; Carretta, A.; Zannini, P.

In: Clinical Intensive Care, Vol. 9, No. 2, 1998, p. 77-80.

Research output: Contribution to journalArticle

Gemma, M, Cozzi, S, Cipriani, A, Calvi, MR, Garancini, P, Melloni, G, Carretta, A & Zannini, P 1998, 'Cerebral perfusion pressure during percutaneous dilatational tracheostomy', Clinical Intensive Care, vol. 9, no. 2, pp. 77-80.
Gemma M, Cozzi S, Cipriani A, Calvi MR, Garancini P, Melloni G et al. Cerebral perfusion pressure during percutaneous dilatational tracheostomy. Clinical Intensive Care. 1998;9(2):77-80.
Gemma, M. ; Cozzi, S. ; Cipriani, A. ; Calvi, M. R. ; Garancini, P. ; Melloni, G. ; Carretta, A. ; Zannini, P. / Cerebral perfusion pressure during percutaneous dilatational tracheostomy. In: Clinical Intensive Care. 1998 ; Vol. 9, No. 2. pp. 77-80.
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AU - Gemma, M.

AU - Cozzi, S.

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AU - Garancini, P.

AU - Melloni, G.

AU - Carretta, A.

AU - Zannini, P.

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N2 - Objective: To assess the impact of the Ciaglia percutaneous dilatational tracheostomy (PDT) on intracranial pressure (ICP) in patients with severe brain injury. Design: Prospective observational study. Setting: Neurosurgical intensive car unit (nICU) of a university hospital. Subjects: Fifteen patients admitted to our nICU with severe brain injury, for whom PDT was scheduled provided that: i) prolonged nasotracheal intubation was anticipated because of the lack of adequate spontaneous ventilation and/or airway protection; ii) no haemostatic defect was apparent; iii) no lesions of the neck (traumatic, neoplastic, infectious, etc) were present; iv) extension of the neck was possible and did not cause ICP elevation; v) ICP was monitored via an intraparenchymal Camino device. Over the previous 24 hours cerebral perfusion pressure (CPP) was always ≤ 70 mmHg, ICP ≤ 20 mmHg and cerebrospinal fluid was not drained. Interventions: Ciaglia percutaneous dilatational tracheostomy. Measurements and main results: CPP was recorded at a 20/min sample rate during PDT. The occurrence of a CPP mean value <70 mmHg over 1 minute was defined as a cerebral hypoperfusion episode (CHE). CHEs occurred during PDT in eight patients - mean number of CHEs 11 (SD 6; range: 3-18). The mean longest CHE was eight (SD 5; range: 2-16) min. CHEs were due to ICP increases and not to falls in mean arterial pressure. The number of CHEs was associated with the baseline ICP quadratic term: r2 = 0.60 (p = 0.004) and r2 = 0.63 (p = 0.002) respectively, with an increasing number of CHEs for baseline ICP values above 10 mmHg. Conclusions: The Ciaglia PDT technique carries a potential risk for causing cerebral hypoperfusion in nICU patients. This risk can be substantially higher in patients with a higher baseline ICP, even if only those patients with 'safe' baseline ICP values <20 mmHg undergo PDT. Optimal management of PDT in neurosurgical patients should include CPP monitoring.

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