The Impact of Intrahospital Transports on Brain Tissue Metabolism in Patients with Acute Brain Injury
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Patients with severe acute brain injury (ABI) often require intrahospital transports (IHTs) for repeated computed tomography (CT) scans. IHTs are associated with serious adverse events (AE) that might pose a risk for secondary brain injury. The goal of this study was to assess IHT-related alterations of cerebral metabolism in ABI patients.
We included mechanically ventilated patients with ABI who had continuous multimodality neuromonitoring during an 8-h period before and after routine IHT. Intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygenation (PtiO2) as well as cerebral and subcutaneous microdialysis parameters (lactate, pyruvate, glycerol, and glutamate) were recorded. Values were compared between an 8-h period before (pre-IHT) and after (post-IHT) the IHT.
A total of 23 IHT for head CT scans in 18 patients were analyzed. Traumatic brain injury (n = 7) was the leading cause of ABI, followed by subarachnoid hemorrhage (n = 6) and intracerebral hemorrhage (n = 5). The analyzed microdialysis parameters in the brain tissue as in the subcutaneous tissue did not show significant changes between the pre-IHT and post-IHT period. In addition, we observed no significant increase in ICP or decrease in CPP and PtiO2 in the 8-h period after IHT.
While the occurrence of AE during IHT is a known risk factor for ABI patients, our results demonstrate that IHTs do not alter the brain tissue chemistry in a significant manner. This fact may help assess the risk for routine IHT more accurately.
KeywordsAcute brain injury Intrahospital transport Neuromonitoring Cerebral microdialysis
JK contributed to conception and design of the study, statistical analysis and interpretation of data, drafting of the article, and final approval of the version to be published. FT contributed to acquisition of data, revision of the article for important intellectual content, and final approval of the version to be published. ES contributed to acquisition of data, drafting and revision of the article, and final approval of the version to be published. JG and VMT contributed to conception and study design, revision of the article for important intellectual content, and final approval of the version to be published. CD contributed to conception and design of the study, analysis and interpretation of data, drafting of the article, and final approval of the version to be published.
Source of support
The authors received no financial support for this study.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study has been approved by the institutional ethics committee. For this type of retrospective study, formal consent is not required.
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