Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Kasapas Konstantinos
Dissertation committee:
Στράντζαλης Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κουράκλης Γρηγόριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μεντζελόπουλος Σπυρίδων, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Πιάγκου Μαρία, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μάγειρα Ελένη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Βασιλειάδης Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σταυρινού Λάμπης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Επεμβατική και υπερηχοτομογραφική μελέτη της ενδοκράνιας πίεσης σε πειραματικό ζωικό μοντέλο ενδοκράνιας υπέρτασης
Translated title:
Invasive and ultrasound based monitoring of intracranial pressure in an experimental animal model of intracranial hypertension
Summary:
Introduction: Increased intracranial pressure (ICP) is an important and potentially fatal complication of traumatic brain injury and occurs in the context of the development of secondary traumatic brain lesions. Early and targeted treatment of intracranial hypertension can contribute to a better patient prognosis. In this direction, both invasive and non-invasive intracranial pressure monitoring methods play an important role in identifying ICP and monitoring its changes. Although placement of an intracranial pressure catheter remains the gold standard, in recent years, among other methods, ultrasound methods they are constantly gaining ground to the field of neuromonitoring.
Purpose: In the present study, we attempted to induce increased intracranial pressure in experimental animals through traumatic brain injury (epidural hematoma). We correlated the values of the invasive measurement of intracranial hypertension via the intraparenchymal catheter in relation to the findings of the following sonographic methods: transcranial color-coded-Doppler (TCCD), optic nerve sheath diameter, ONSD) and Pupil Constriction Velocity (PCV) after a pupillary light reflex (PLR). In this way, we tried to conclude to statistically significant data that will strengthen the usefulness of non-invasive ICP monitoring methods in clinical practice, in relation to the already proven use of invasive methods.
Materials and Methods: A total of 20 adults rabbits were included in the final analyses. Initially the procedure included anesthetizing and intubating the animal, as well as recording of initial vital signs, pupil diameter and pupillary light reflex. This was followed by bilateral burr holes and placement of an intraparenchymal catheter to measure ICP and placement of an epidural catheter to induce epidural hematoma. Subsequently, autologous blood was gradually injected into the epidural catheter and intracranial pressure values were recorded through the intraparenchymal catheter. The main part of the procedure included the ultrasonographic studies of intracranial pressure through TCCD in the middle cerebral artery, PI pulsatility index, optic nerve sheath diameter and pupillary constriction velocity.
Results: During the initial phase of intracranial hypertension, as recorded through clinical signs, there was a simultaneous increase in ICP measurements, as well as a significant increase in PI and ONSD. A significant decrease was also noted in the pupillary constriction velocity after the PRL test. It is worth noting that the continuous increase in ICP was combined with a constant increase in PI until the point that a brain herniation was established (by that time PI values could no longer be recorded).
Discussion: Upon completion of the specific research protocol, we were able to conclude to a statistically significant correlation between the non-invasive and invasive methods of measuring intracranial pressure in an experimental animal model of traumatic brain injury. PI induced by TCD, ONSD and PCV after PRL test appeared to be significantly related to invasive ICP monitoring. This scientific observation can be established as a rationale of ultrasound protocol in intensive care units in patients with intracranial hypertension in daily practice. Undoubtedly, non-invasive neuromonitoring is a promising field of research that can contribute to the best possible management of an intubated patient. Clearly, further research is mandatory to fully elucidate its role and ultimately establish ultrasound in the field of neuromonitoring.
Main subject category:
Health Sciences
Keywords:
Intracranial pressure, Intracranial hypertension, Traumatic brain injury, Invasive monitoring, Ultrasound based monitoring
Number of references:
267
