Influencia de la elevación de la cabeza sobre la presión intracraneal, presión de perfusión cerebral y saturación de oxígeno cerebral regional en pacientes con hemorragia cerebral

Palazón, J. Hernández; Asensi, P Doménech; Lopez, Sandrine; Bautista, F. Pérez; Candel, Antonio García

doi:10.1016/s0034-9356(08)70572-3

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…In some studies conducted on similar patient groups in previous years, it has been determined that the ideal head height should be 30° (Köse & Hatipoğlu, 2012; Palazón et al, 2008). In addition, in a study, conducted in patients with acute stroke, it was reported that increasing the head height while aspiration was applied to the patients decreased the blood flow velocity on the side on which the lesion resides.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of endotracheal aspiration at different head heights on oxygenation of the brain by non‐invasive method in intensive care patients

Köstekli

Çelik

Keskin

2022

Journal of Clinical Nursing

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Objectives To determine the effect of endotracheal aspiration at different head heights on oxygenation brain by non‐invasive method in neurosurgery intensive care patients. Background Head elevation of mechanical ventilator‐dependent neurosurgery patients and the possible risks of endotracheal aspiration are closely related to the clinical conditions of the patients. Design A prospective quasi‐experimental study with repetitive measurements in a single group. Methods In the study, neurosurgery intensive care patients were adjusted to a head height of 15, 30 and 45° (n = 46, power analysis %90). Cerebral oxygenation levels were determined with a non‐invasive device at each head height before and in the 1st, 5th and 30th min of endotracheal aspiration. Data were collected with Patient Information Form and cerebral oxygenation device based on NIRS technology. This study performed according to the TREND reporting guidelines for non‐randomized/quasi experimental study. Results The highest cerebral oxygenation value was obtained at 30 min. The decrease in the cerebral oxygenation levels of the patients was highest in the 1st min after endotracheal aspiration, at a head height of 15 degrees for the right cerebral region and at a head height of 30 degrees for the left cerebral region. The increase in oxygenation of the right and left cerebral regions occurred highest at a head height of 45 degrees. Conclusions The ideal head height should be 45 degrees during and after endotracheal aspiration in regard to maintaining cerebral oxygenation in neurosurgery intensive care patients. It is extremely important to monitor the cerebral oxygenation status of patients, with non‐invasive measurement tools during and after endotracheal aspiration, to prevent secondary complications. Relevance to clinical practice This study reveals the importance of raising the head 45 degrees in the best preservation of cerebral oxygenation values in neurosurgery intensive care patients. Intensive care nurses should pay attention to maintaining this head height.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of endotracheal aspiration at different head heights on oxygenation of the brain by non‐invasive method in intensive care patients

Köstekli

Çelik

Keskin

2022

Journal of Clinical Nursing

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“…Changes in rSO 2 and V-MCA were associated with the changes in ICP and CPP [ 34 , 35 ]. The change in rSO 2 is negatively correlated with the change in ICP and positively correlated with the change in CPP [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Zhao

Wang

et al. 2021

Med Sci Monit

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Background This study aimed to determine the effects of alveolar recruitment maneuver (RM) on cerebral oxygen saturation and cerebral blood velocity in patients undergoing carotid endarterectomy (CEA) before clamping of the carotid artery. Material/Methods In this crossover exploratory study, all patients were randomized to undergo an RM (30 cmH 2 O of continuous airway pressure for 30 s) and a “sham” maneuver (SM; 5 cmH 2 O for 30 s), followed by an alternative intervention after a 5-min equilibration period. Near-infrared spectroscopy (NIRS) was used to monitor regional cerebral oxygen saturation (rSO 2 ), and transcranial Doppler ultrasonography (TCD) to evaluate blood velocity of the middle cerebral artery (V-MCA). Changes in rSO 2 , V-MCA, mean arterial pressure (MAP), and heart rate (HR) in response to the 2 interventions were compared. Results A total of 59 patients underwent the study procedure. RM reduced rSO 2, V-MCA, MAP, and HR, but these variables slightly changed during SM. A significant drop in rSO 2 was observed immediately after RM compared with the baseline value (68.51±4.4% vs 64.12±5.15%; P <0.001). The decrease in rSO 2 was higher during the RM than during the SM (−6±4% vs 1±2%; P <0.001). Similarly, change in V-MCA was more significant in response to RM than SM (−26±19% vs 19±16%; P <0.001). The V-MCA value changed from 39 cm/s to 29 cm/s after RM. In addition, V-MCA of the ipsilateral to the surgical side decreased more obviously than the contralateral side (−26±19% vs −20±17%; P =0.001). Conclusions An RM at 30 cmH 2 O of continuous airway pressure for 30 s decreased rSO 2 and V-MCA. In addition, MAP and HR were affected.

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“…Además se ha constatado que el efecto benéfico de la elevación de la cabeza para disminuir la PiC puede estar asociado a una reducción de la presión de perfusión cerebral (PPC) y del flujo sanguíneo cerebral (FSC), que conllevaría a un aumento del riesgo de isquemia cerebral, sobre todo si la elevación de la cabeza es superior a 30 grados. 23 Así, la elevación de la cabeza produce una disminución significativa de la PiC y la PPC en pacientes con hemorragia cerebral, sometidos a sedoanalgesia y ventilación mecánica. Estos autores encontraron que la elevación de la cabeza en paciente con hemorragia cerebral puede afectar los valores de Sro2, dependiendo la intensidad de los cambios de la Sro2 del grado de elevación de la cabeza, sobre todo a 45º donde alcanzaría valores compatibles con isquemia cerebral.…”

Section: Necesidad Alteradaunclassified

“…Estos autores encontraron que la elevación de la cabeza en paciente con hemorragia cerebral puede afectar los valores de Sro2, dependiendo la intensidad de los cambios de la Sro2 del grado de elevación de la cabeza, sobre todo a 45º donde alcanzaría valores compatibles con isquemia cerebral. 23 Controlar el procedimiento de aspiración de secreciones para minimizar el aumento de la PiC. la aspiración de secreciones es una técnica de enfermería habitual en los pacientes sometidos a ventilación mecánica, que puede ser causa de elevación de la presión intracraneal (PiC).…”

Section: Necesidad Alteradaunclassified

Estudio de caso a una persona con alteración en la necesidad de oxigenación secundaria a hemorragia intraparenquimatosa basado en el modelo conceptual de Virginia Henderson

Quiroz

2018

Enferm. univ.

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El presente estudio de caso se realizó en un adulto en estado crítico con diagnóstico médico de Hemorragia Intraparenquimatosa, atendido en un Hospital de Alta especialidad. Se utilizó el Modelo de Virginia Henderson para la valoración de necesidades, y se complementó con la valoración neurológica. La metodología establecida fue con la NANDA en la emisión de diagnósticos y la Clasificación de los Resultados de Enfermería (NOC) y la Clasificación de las Intervenciones de Enfermería (NIC) para la planificación del cuidado. Se utilizó la red de razonamiento clínico para la resolución del caso, según el modelo AREA (Análisis de Resultados del Estado Actual), propuesto por Pesut. El razonamiento clínico permite analizar la relación que existe entre diagnósticos y la influencia que tienen unos con otros, lo que lleva a la enfermera a identificar el diagnóstico prioritario. A partir de lo anterior se desarrolló un plan de cuidados priorizando las necesidades más alteradas y las intervenciones especializadas. La red de razonamiento se representó a través de líneas que conectan a los diagnósticos entre sí, lo que explica cómo y porqué unos diagnósticos influyen en otros. Dentro del perfil del especialista en Enfermería del Adulto en Estado Crítico, el razonamiento clínico es la manera de estructurar el pensamiento crítico, como un proceso que fundamenta los cuidados especializados por medio del conocimiento científico, la toma de decisiones, la prontitud en la manera de pensar, actuar , y la intuición. Herramientas fundamentales de un especialista.

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Influencia de la elevación de la cabeza sobre la presión intracraneal, presión de perfusión cerebral y saturación de oxígeno cerebral regional en pacientes con hemorragia cerebral

Cited by 8 publications

References 18 publications

Evaluation of the effect of endotracheal aspiration at different head heights on oxygenation of the brain by non‐invasive method in intensive care patients

Evaluation of the effect of endotracheal aspiration at different head heights on oxygenation of the brain by non‐invasive method in intensive care patients

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Estudio de caso a una persona con alteración en la necesidad de oxigenación secundaria a hemorragia intraparenquimatosa basado en el modelo conceptual de Virginia Henderson

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