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Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients
Uppsala universitet, Neurokirurgi.ORCID iD: 0000-0001-8008-8169
Uppsala universitet, Neurokirurgi.
Uppsala universitet, Neurokirurgi.
2009 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 11, no 2, p. 135-142Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate the effects of the neurological "wake-up test" (NWT), defined as interruption of continuous propofol sedation and evaluation of the patient's level of consciousness, on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI). METHODS: A total of 127 NWT procedures in 21 severely brain-injured adult patients with either TBI (n = 12) or SAH (n = 9) were evaluated. ICP and CPP levels prior to, during and after the NWT procedure were recorded. RESULTS: During the NWT, ICP increased from 13.4 +/- 6 mmHg at baseline to 22.7 +/- 12 (P < 0.05) and the CPP increased from 75.6 +/- 11 to 79.1 +/- 21 mmHg (P < 0.05) in TBI patients. Eight patients showed a reduced CPP during the NWT due to increased ICP. In SAH patients, ICP increased from 10.6 +/- 5 to 16.8 +/- 8 mmHg (P < 0.05) and the CPP increased from 76.9 +/- 13 to 84.6 +/- 15 mmHg (P < 0.05). CONCLUSION: When continuous propofol sedation was interrupted and NWT was performed in severely brain-injured patients, the mean ICP and CPP levels were modestly increased. A subset of patients showed more pronounced changes. To date, the role of the NWT in the neurointensive care of TBI and SAH patients is unclear. Although the NWT is safe in the majority of patients and may provide useful clinical information about the patient's level of consciousness, alternate monitoring methods are suggested in patients showing marked ICP and/or CPP changes during NWT.

Place, publisher, year, edition, pages
2009. Vol. 11, no 2, p. 135-142
Keywords [en]
Intracranial pressure, Cerebral perfusion pressure, Sedation, Propofol, Wake-up test, Neurological examination, Reaction Level Scale, Glasgow Coma Scale
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-21972DOI: 10.1007/s12028-009-9255-3ISI: 000269902300002PubMedID: 19644774Scopus ID: 2-s2.0-70350567662OAI: oai:DiVA.org:mdh-21972DiVA, id: diva2:656807
Available from: 2009-11-24 Created: 2013-10-17 Last updated: 2017-12-06Bibliographically approved

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