Continuous Monitoring of ICP and CPP Following ICH and its Relationship to Clinical, Radiological and Surgical Parameters

Fernandes, Hilda; Siddique, Shahid; Banister, K.; Chambers, I. R.; Wooldridge, Thomas D.; Gregson, Barbara; Mendelow, A. D.

doi:10.1007/978-3-7091-6346-7_96

Cited by 41 publications

(32 citation statements)

References 7 publications

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“…5 After the acute phase, high morbidity and mortality are essentially caused by the evolution of a peri-hemorrhagic, space-occupying edema associated with gradually increasing intracranial pressure (ICP). 6,7 Although the natural course of edema formation is still not fully understood, edema commonly increases strongly during the first week and reaches its maximum during the second week after bleeding onset. 8 To date, there is no effective therapy for spontaneous ICH.…”

mentioning

confidence: 99%

Hypothermia Reduces Perihemorrhagic Edema After Intracerebral Hemorrhage

Kollmar

Staykov

Dörfler

et al. 2010

Stroke

172

101

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Background and Purpose-The prognosis of spontaneous intracerebral hemorrhage (sICH) is poor because of the mass effect arising from the hematoma and the associated peri-hemorrhagic edema, leading to increased intracranial pressure. Because the efficacy of surgical and anti-edematous treatment strategies is limited, we investigated the effects of mild induced hypothermia in patients with large sICH. Methods-Twelve patients with supratentorial sICH Ͼ25 mL were treated by hypothermia of 35°C for 10 days. Evolution of hematoma volume and perifocal edema was measured by cranial CT. Functional outcome was assessed after 90 days. These patients were compared to patients (nϭ25; inclusion criteria: sICH volume Ͼ25 mL, no acute restriction of medical therapy on admission) from the local hemorrhage data bank (nϭ312). Side effects of hypothermia were analyzed. Results-All patients from both groups needed mechanical ventilation and were treated in a neurocritical care unit. All hypothermic patients (mean age, 60Ϯ10 years) survived until day 90, whereas 7 patients died in the control group (mean age, 67Ϯ7 years). Absolute hematoma size on admission was 58Ϯ29 mL (hypothermia) compared to 57Ϯ31 mL (control). In the hypothermia group, edema volume remained stable during 14 days (day 1, 53Ϯ43 mL; day 14, 57Ϯ45 mL), whereas edema significantly increased in the control group from 40Ϯ28 mL (day 1) to 88Ϯ47 mL (day 14). ICH continuously dissolved in both groups. Pneumonia rate was 100% in the hypothermia group and 76% in controls (Pϭ0.08). No significant side effects of hypothermia were observed. Conclusions-Hypothermia prevented the increase of peri-hemorrhagic edema in patients with large sICH. (Stroke. 2010; 41:1684-1689.)

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mentioning

confidence: 99%

Hypothermia Reduces Perihemorrhagic Edema After Intracerebral Hemorrhage

Kollmar

Staykov

Dörfler

et al. 2010

Stroke

172

101

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“…3 After the acute phase, neurological deterioration is mainly attributed to the evolution of perihemorrhagic edema with mass effect and increasing intracranial pressure (ICP). 4 Although only a few studies have investigated the course of edema evolution, it seems that there is a strong increase during the first week and a peak in the second week after initial bleeding. 5 To date, no medical or surgical therapy for ICH and perihemorrhagic edema has been shown to improve outcome after ICH.…”

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confidence: 99%

Effects of Continuous Hypertonic Saline Infusion on Perihemorrhagic Edema Evolution

Wagner

Hauer

Staykov

et al. 2011

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Background and Purpose-Mass effect of hematoma and the associated perihematomal edema are commonly responsible for neurological deterioration after intracerebral hemorrhage. Efficacy of surgical and medical therapy is limited. We studied the effect of early continuous hypertonic saline infusion on development of perihematomal edema after severe spontaneous supratentorial hemorrhage. Methods-Patients with spontaneous lobar and basal ganglia/thalamic bleeding Ͼ30 mL (nϭ26) were treated with early (Ͻ72 hours) continuous hypertonic saline infusion (3%) to achieve sodium of 145 to 155 mmol/L and osmolality of 310 to 320 mOsmol/kg. Evolution of absolute edema volume and relative edema volume (ratio absolute edema volume/initial hematoma volume) was assessed on repeated cranial CT and compared to historical patients (nϭ64) identified on database with hematoma Ͼ30 mL. Results-In the treatment group, absolute edema volume was significant smaller between day 8 and day 14 (P absolute edema volume ϭ 0.04) and relative edema volume was significant smaller between day 2 and day 14 (P relative edema volume ϭ0.02).Intracranial pressure crisis (Ͼ20 mm Hg for Ͼ20 minutes or new anisocoria) occurred less frequently in the treatment group (12 versus 56; Pϭ0.048). In-hospital mortality was 3 (11.5%) in the hypertonic saline group and 16 (25%) in the control group (Pϭ0.078). Side effects theoretically associated with hypertonic saline including cardiac arrhythmia and acute heart and renal failure occurred in both groups to a similar extent. Conclusions-Early

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“…Mayer et al investigated the potential use of rFVIIa for improving outcome and established that this therapy may in fact improve hematoma volume, but its impact on outcomes was limited (18). Hematoma volume & growth does correlate with various outcome measures (19)(20)(21), but so does perihemorrhagic edema (22)(23)(24)(25). ICH is associated with secondary injury characteristics that are similar to ischemia and ischemia-reperfusion, including blood-brain barrier disruption, inflammation and edema.…”

Section: Therapeutic Hypothermia For Intracerebral Hemmorhagementioning

confidence: 99%

“…The edema progresses through three phases related initially to hydrostatic forces & clot retraction, then activation of the coagulation cascade and thrombin formation and later, via RBC lysis and hemoglobin-induced neuronal toxicity (26). This edema -termed perihemorrhagic edema -has been associated with poor outcomes (22,23,25). Data from animal models of ICH suggest that hypothermia can improve these injurious processes, but not outcomes (27)(28)(29)(30)(31)(32)(33).…”

Section: Therapeutic Hypothermia For Intracerebral Hemmorhagementioning

confidence: 99%

Hypothermia for Intracerebral Hemorrhage, Subarachnoid Hemorrhage & Spinal Cord Injury

Tannehill¹

2013

Therapeutic Hypothermia in Brain Injury

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Continuous Monitoring of ICP and CPP Following ICH and its Relationship to Clinical, Radiological and Surgical Parameters

Cited by 41 publications

References 7 publications

Hypothermia Reduces Perihemorrhagic Edema After Intracerebral Hemorrhage

Hypothermia Reduces Perihemorrhagic Edema After Intracerebral Hemorrhage

Effects of Continuous Hypertonic Saline Infusion on Perihemorrhagic Edema Evolution

Hypothermia for Intracerebral Hemorrhage, Subarachnoid Hemorrhage & Spinal Cord Injury

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