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 journalArticlepeer-review

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

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

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