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A.A. Sychev

Burdenko National Medical Research Center for Neurosurgery

I.A. Savin

Burdenko National Medical Research Center for Neurosurgery

A.I. Baranich

Burdenko National Medical Research Center for Neurosurgery

G.V. Danilov

Burdenko National Medical Research Center for Neurosurgery

Yu.V. Strunina

Burdenko National Medical Research Center for Neurosurgery

A.V. Oshorov

Burdenko National Medical Research Center for Neurosurgery

A.A. Polupan

Burdenko National Medical Research Center for Neurosurgery

Hemodynamic profile in acute period of severe traumatic brain injury

Authors:

A.A. Sychev, I.A. Savin, A.I. Baranich, G.V. Danilov, Yu.V. Strunina, A.V. Oshorov, A.A. Polupan

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2023;(3): 32‑36

DOI: 10.17116/anaesthesiology202303132

Views: 2521

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Table of contents

HEMODYNAMIC PROFILE IN ACUTE PERIOD OF SEVERE TRAUMATIC BRAIN INJURY
HEMODYNAMIC PROFILE IN ACUTE PERIOD OF SEVERE TRAUMATIC BRAIN INJURY

To cite this article:

Sychev AA, Savin IA, Baranich AI, Danilov GV, Strunina YuV, Oshorov AV, Polupan AA. Hemodynamic profile in acute period of severe traumatic brain injury. Russian Journal of Anesthesiology and Reanimatology. 2023;(3):32‑36. (In Russ., In Engl.)
https://doi.org/10.17116/anaesthesiology202303132

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Arterial hypotension in acute period of severe traumatic brain injury (TBI) reduces cerebral perfusion pressure and increases the risk of ischemic brain damage.

OBJECTIVE

To analyze hemodynamic profile of patients in acute period of TBI using transpulmonary thermodilution (PiCCO).

MATERIAL AND METHODS

A prospective observational study included 54 patients with severe TBI who admitted to intensive care unit in 1—5 days after injury.

RESULTS

In most cases, the highest systemic vascular resistance index was observed on the 1st day of monitoring including due to severe hypovolemia following dehydration. In most patients, we achieved systolic blood pressure ≥100 mm Hg. However, we considered stroke volume variability for more physiological state of systemic hemodynamics and microcirculation. It was possible to reduce the doses of sympathomimetics due to higher rate and volume of infusion therapy. Under these conditions, extravascular lung fluid index could exceed 7 ml/kg.

CONCLUSION

Correction of arterial hypotension in patients with severe TBI should be based on assessment of all hemodynamic parameters and individual variability of changes at a particular stage of disease.

Keywords:

traumatic brain injury
TBI
hemodynamics
transpulmonary thermodilution
PiCCO
vasopressors
blood pressure

Authors:

A.A. Sychev

Burdenko National Medical Research Center for Neurosurgery

I.A. Savin

Burdenko National Medical Research Center for Neurosurgery

A.I. Baranich

Burdenko National Medical Research Center for Neurosurgery

G.V. Danilov

Burdenko National Medical Research Center for Neurosurgery

Yu.V. Strunina

Burdenko National Medical Research Center for Neurosurgery

A.V. Oshorov

Burdenko National Medical Research Center for Neurosurgery

A.A. Polupan

Burdenko National Medical Research Center for Neurosurgery

Received:

26.04.2022

Accepted:

23.01.2023

List of references:

  1. Kinoshita K. Traumatic brain injury: pathophysiology for neurocritical care. Journal of Intensive Care. 2016;4:29.  https://doi.org/10.1186/s40560-016-0138-3
  2. Shibahashi K, Sugiyama K, Okura Y, Tomio J, Hoda H, Hamabe Y. Defining Hypotension in Patients with Severe Traumatic Brain Injury. World Neurosurgery. 2018;120:667-674.  https://doi.org/10.1016/j.wneu.2018.08.142
  3. Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80(1):6-15.  https://doi.org/10.1227/NEU.0000000000001432
  4. Lekmanov AU, Azovskiy DK, Ponomareva NA. Myths and realities of transpulmonary thermodilution in children. Anesteziologiya i Reanimatologiya. 2021;1:60-64. (In Russ.). https://doi.org/10.17116/anaesthesiology202101160
  5. Samokhvalov IM, Gavrilin SV, Meshakov DP, Nedomolkin SV, Badalov VI, Suvorov VV, Suprun TYu, Sokhranov MV, Smirnov SA. The patterns of the hemodynamics monitoring in the bad concomitant injury patients. Vestnik anesteziologii i reanimatologii. 2015;12(3):34-40. (In Russ.). https://doi.org/10.21292/2078-5658-2015-12-3-34-40
  6. Schulte Esch J, Murday H, Pfeifer G. Haemodynamic changes in patients with severe head injury. Acta Neurochirurgica. 1980;54(3-4):243-250.  https://doi.org/10.1007/BF01407091
  7. Tamaki T, Isayama K, Yamamoto Y, Teramoto A. Cardiopulmonary haemodynamic changes after severe head injury. British Journal of Neurosurgery. 2004;18(2):158-163.  https://doi.org/10.1080/02688690410001681019
  8. Yamada R, Katsurada K, Sugimoto T. Haemodynamic defect in patients with severe head injury. Injury. 1975;6(4):351-357.  https://doi.org/10.1016/0020-1383(75)90192-8
  9. Potapov AA, Krylov VV, Gavrilov AG, Kravchuk AD, Likhterman LB, Petrikov SS, Talypov AE, Zakharova NE, Oshorov AV, Sychev AA, Alexandrova EV, Solodov AA. Recommendations for the diagnosis and treatment of severe traumatic brain injury. Part 2. Intensive care and neuromonitoring. Zhurnal Voprosy nejrokhirurgii im. N.N. Burdenko. 2016;80(1):98-106. (In Russ.).
  10. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172-178.  https://doi.org/10.1378/chest.07-2331
  11. Kuz’kov VV, Kirov MYu. Invazivnyj monitoring gemodinamiki v intensivnoj terapii i anesteziologii: monografiya. Arkhangel’sk: Severnyj gosudarstvennyj meditsinskij universitet; 2015. (In Russ.).

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