The Application Of Multimodal Monitoring In Neurocritical Care

Part?:The value of ventricular intracranial pressure monitoring for traumatic bifrontal contusionsObjectiveTo retrospective analysis the clinical value and guidance for traumatic bifrontal contusions patients.The treatment effect and security were compared between ventricular ICP monitoring group and conventional group.The evaluation indicators include GOS score after 6 months,the rate of craniotomy,rate of DC,LOS(length of stay)and HE(hospitalization expenses).MethodsWe reviewed 85 patients who were diagnosed with traumatic bifrontal contusions between June 2014 and June 2015 at Shandong Provincial Hospital,which is affiliated with Shandong University,and Yidu Central Hospital of Weifang,and PLA 101 hospital.This retrospective study was divided into two groups,an ventricular intracranial pressure(ICP)monitoring group and a non-ICP monitoring group(clinical condition and CT re-examination).These two groups will be compared GOS score after 6 months,the rate of craniotomy,rate of DC,LOS(length of stay)and HE(hospitalization expenses).And to compared the security in two group by re-bleeding and intracranial infection.ResultsThere were no significant differences in outcome between the two groups,according to the GOS at 6 months after injury(P>0.05).Compared with the non-ICP monitoring group,the rate of conservative treatment success was higher,large trauma craniotomy clearly decreased and the rate of bilateral craniotomy was decreased in the ICP monitoring group.In addition,the hospitalization expenses and lengths of hospital stays clearly decreased(P<0.05).Also,there were no significant differences in re-bleeding and intracranial infection between the two groups(P>0.05)ConclusionsVentricular ICP monitoring for targeted management of traumatic bifrontal contusions may have beneficial effects by decreasing the complications,hospitalization expenses and lengths of hospital stays,minimize the operation damage.And it do not increase intracranial re-bleeding and infection,it should be popolarized and applied.Part ?:The clinical value of TCD monitoring for severe TBIObjectiveTo study the relationship between ICP,CPP and TCD parameter at severe TBI patients,and to explore and evaluated the cerebrovascular vasospasm(CVS)and outcome after severe TBI.MethodsWe retrospectively reviewed 53 patients who were diagnosed with severe TBI patients between June 2014 and June 2015.All patients received ICP monitoring,and also received TCD monitoring to evaluated MCA images at second day after operation,and to measure Vd,Vs and Vm,we also can count PI and RI.We monitoring the ICP and TCD every day and record all data.Analyze the TCD spectrum images and parameter and its relationship between of ICP,CPP,GOS after 6 months was evaluated for every patient.ResultsTCD parameter had significantly change after ICP increased progressively at severe TBI patients.When ICP was increased,RI and PI also increased,Vd and Vm were decreased,and Vd was significantly.The result shows that a positive correlation exists between PI,RI and ICP,a negative correlation exists between Vd,Vm and ICP.And there was an obvious positive correlation between the CPP and the Vs,Vd,Vm,an obvious negative correlation between the CPP and the RI,the most relevant was PI.The Vs and Vd had dropped to the lowest at the seventh day after TBI,then gradually being restored to normal,PI parameter was the opposite of cerebral blood flow velocity.Additionally,our study found that more than 30%severe TBI patients occurred CVS,and severe CVS can lead severe neurological dysfunction,lead a poor outcome.Conclusions1.TCD monitoring can confirm the relationship of TCD parameter and ICP,CPP,and it also can provide evidence for noninvasive ICP monitoring.2.TCD monitoring can evaluate the CVS easily at early time for severe TBI patients,and provide basis of treatment,and can predicate preliminarily the clinical prognosis.Part ?:The clinical value of BIS monitoring for severe TBIObjectiveTo study the clinical value of BIS in severe TBI.The relationship between initial BIS and outcome,and to explore and evaluated the value of BIS in NICU sedation and analgesia after severe TBI.MethodsWe retrospectively reviewed 72 patients who were diagnosed with severe traumatic brain injury between Dec 2014 and Dec 2017 at Shandong Provincial Hospital,which is affiliated with Shandong University,and Yidu Central Hospital of Weifang,and PLA 101 hospital.This retrospective study was divided into two groups,an BIS monitoring group and a non-BIS monitoring group.All patients received long time sedation and analgesia in NICU.The deep of sedation and analgesia according to BIS in BIS monitoring group,and other group was not.These two groups will be compared GOS score after 6 months,the rate of pulmonary infection,rate of disturbance of blood coagulation,arrhythmia electrolyte disturbance,and ICP also was stable.ResultsThere was no difference in baseline data between the two groups.To compared with non-BIS monitoring group,the rate of pulmonary infection(P<0.05),electrolyte disturbance was significant lower(P<0.05),the disturbance of blood coagulation was similar in two group(P>0.05).But,ICP was more stable controlled in BIS monitoring group than non-BIS monitoring group.According to the GOS at 6 months after injury,the initial BIS was higher,the outcome was better,the outcome in higher BIS group was better than low BIS group(P<0.05).Conclusions1.We found BIS monitoring can revise the deep of sedation and analgesia,also benefits for management hypothermia treatment;2.BIS monitoring can reduce the rate of complications after sedation and analgesia;3.The initial BIS was related to the outcome after severe TBI,the initial BIS was higher,and the outcome was better.