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Neurocritical Care

, Volume 30, Issue 1, pp 216–223 | Cite as

The Impact of Intrahospital Transports on Brain Tissue Metabolism in Patients with Acute Brain Injury

  • Jan KüchlerEmail author
  • Franziska Tronnier
  • Emma Smith
  • Jan Gliemroth
  • Volker M. Tronnier
  • Claudia Ditz
Original Article
  • 118 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Acute brain injury Intrahospital transport Neuromonitoring Cerebral microdialysis 

Notes

Author Contribution

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.

Ethical Approval

The study has been approved by the institutional ethics committee. For this type of retrospective study, formal consent is not required.

References

  1. 1.
    Jeremitsky E, Omert L, Dunham CM, Protetch J, Rodriguez A. Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma. 2003;54:312–9.CrossRefGoogle Scholar
  2. 2.
    Unterberg AW, Stover J, Kress B, Kiening KL. Edema and brain trauma. Neuroscience. 2004;129:1021–9.CrossRefGoogle Scholar
  3. 3.
    Brown CV, Zada G, Salim A, et al. Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury. J Trauma. 2007;62:1339–44.CrossRefGoogle Scholar
  4. 4.
    Tasneem N, Samaniego EA, Pieper C, et al. Brain multimodality monitoring: a new tool in neurocritical care of comatose patients. Crit Care Res Pract. 2017;2017:6097265.Google Scholar
  5. 5.
    John S, Stock S, Cerejo R, et al. Brain imaging using mobile CT: current status and future prospects. J Neuroimaging. 2016;26:5–15.CrossRefGoogle Scholar
  6. 6.
    Evans A, Winslow EH. Oxygen saturation and hemodynamic response in critically ill, mechanically ventilated adults during intrahospital transport. Am J Crit Care. 1995;4:106–11.Google Scholar
  7. 7.
    Chaikittisilpa N, Lele AV, Lyons VH, et al. Risks of routinely clamping external ventricular drains for intrahospital transport in neurocritically ill cerebrovascular patients. Neurocrit Care. 2017;26:196–204.CrossRefGoogle Scholar
  8. 8.
    Andrews PJ, Piper IR, Dearden NM, Miller JD. Secondary insults during intrahospital transport of head-injured patients. Lancet (London, England). 1990;335:327–30.CrossRefGoogle Scholar
  9. 9.
    Kleffmann J, Pahl R, Deinsberger W, Ferbert A, Roth C. Intracranial pressure changes during intrahospital transports of neurocritically ill patients. Neurocrit Care. 2016;25:440–5.CrossRefGoogle Scholar
  10. 10.
    Martin M, Cook F, Lobo D, et al. Secondary insults and adverse events during intrahospital transport of severe traumatic brain-injured patients. Neurocrit Care. 2017;26:87–95.CrossRefGoogle Scholar
  11. 11.
    Trofimov A, Kalentiev G, Yuriev M, Pavlov V, Grigoryeva V. Intrahospital transfer of patients with traumatic brain injury: increase in intracranial pressure. Acta Neurochir. 2016;122:125–7.CrossRefGoogle Scholar
  12. 12.
    Nagel A, Graetz D, Schink T, et al. Relevance of intracranial hypertension for cerebral metabolism in aneurysmal subarachnoid hemorrhage. Clinical article. J Neurosurg. 2009;111:94–101.CrossRefGoogle Scholar
  13. 13.
    Ryttlefors M, Howells T, Nilsson P, Ronne-Engstrom E, Enblad P. Secondary insults in subarachnoid hemorrhage: occurrence and impact on outcome and clinical deterioration. Neurosurgery. 2007;61:704–14.CrossRefGoogle Scholar
  14. 14.
    Chen HI, Stiefel MF, Oddo M, et al. Detection of cerebral compromise with multimodality monitoring in patients with subarachnoid hemorrhage. Neurosurgery. 2011;69:53–63.CrossRefGoogle Scholar
  15. 15.
    Bergman LM, Pettersson ME, Chaboyer WP, Carlstrom ED, Ringdal ML. Safety hazards during intrahospital transport: a prospective observational study. Crit Care Med. 2017;45:e1043–9.CrossRefGoogle Scholar
  16. 16.
    Gimenez FMP, de Camargo WHB, Gomes ACB, et al. Analysis of adverse events during intrahospital transportation of critically ill patients. Crit Care Res Pract. 2017;2017:6847124.Google Scholar
  17. 17.
    Parmentier-Decrucq E, Poissy J, Favory R, et al. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care. 2013;3:10.CrossRefGoogle Scholar
  18. 18.
    Schwebel C, Clec’h C, Magne S, et al. Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study*. Crit Care Med. 2013;41:1919–28.CrossRefGoogle Scholar
  19. 19.
    Brunsveld-Reinders AH, Arbous MS, Kuiper SG, de Jonge E. A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients. Crit Care (London, England). 2015;19:214.CrossRefGoogle Scholar
  20. 20.
    Donovan AL, Aldrich JM, Gross AK, et al. Interprofessional care and teamwork in the ICU. Crit Care Med. 2018;46:980–90.CrossRefGoogle Scholar
  21. 21.
    Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. Crit Care (London, England). 2010;14:R87.CrossRefGoogle Scholar
  22. 22.
    Warren J, Fromm RE Jr, Orr RA, Rotello LC, Horst HM. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32:256–62.CrossRefGoogle Scholar
  23. 23.
    Kerwin AJ, Croce MA, Timmons SD, et al. Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: a prospective clinical study. J Trauma. 2000;48:878–82.CrossRefGoogle Scholar
  24. 24.
    Küchler J, Wojak J, Abusamha A, et al. Analysis of extracellular brain chemistry during percutaneous dilational tracheostomy: a retrospective study of 19 patients. Clin Neurol Neurosurg. 2017;159:1–5.CrossRefGoogle Scholar
  25. 25.
    Reinprecht A, Greher M, Wolfsberger S, et al. Prone position in subarachnoid hemorrhage patients with acute respiratory distress syndrome: effects on cerebral tissue oxygenation and intracranial pressure. Crit Care Med. 2003;31:1831–8.CrossRefGoogle Scholar
  26. 26.
    Balestreri M, Czosnyka M, Hutchinson P, et al. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit Care. 2006;4:8–13.CrossRefGoogle Scholar
  27. 27.
    Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34:216–22.CrossRefGoogle Scholar
  28. 28.
    Heuer GG, Smith MJ, Elliott JP, Winn HR, LeRoux PD. Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2004;101:408–16.CrossRefGoogle Scholar
  29. 29.
    Adamides AA, Rosenfeldt FL, Winter CD, et al. Brain tissue lactate elevations predict episodes of intracranial hypertension in patients with traumatic brain injury. J Am Coll Surg. 2009;209:531–9.CrossRefGoogle Scholar
  30. 30.
    Sarrafzadeh AS, Sakowitz OW, Kiening KL, et al. Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med. 2002;30:1062–70.CrossRefGoogle Scholar
  31. 31.
    Timofeev I, Carpenter KL, Nortje J, et al. Cerebral extracellular chemistry and outcome following traumatic brain injury: a microdialysis study of 223 patients. Brain. 2011;134:484–94.CrossRefGoogle Scholar
  32. 32.
    Enblad P, Valtysson J, Andersson J, et al. Simultaneous intracerebral microdialysis and positron emission tomography in the detection of ischemia in patients with subarachnoid hemorrhage. J Cereb Blood Flow Metab. 1996;16:637–44.CrossRefGoogle Scholar
  33. 33.
    Hlatky R, Valadka AB, Goodman JC, Contant CF, Robertson CS. Patterns of energy substrates during ischemia measured in the brain by microdialysis. J Neurotrauma. 2004;21:894–906.CrossRefGoogle Scholar
  34. 34.
    Clausen T, Alves OL, Reinert M, et al. Association between elevated brain tissue glycerol levels and poor outcome following severe traumatic brain injury. J Neurosurg. 2005;103:233–8.CrossRefGoogle Scholar
  35. 35.
    Hutchinson PJ, Jalloh I, Helmy A, et al. Consensus statement from the 2014 international microdialysis forum. Intensive Care Med. 2014;41:1517–28.CrossRefGoogle Scholar
  36. 36.
    Park HK, Joo WI, Chough CK, et al. The clinical efficacy of repeat brain computed tomography in patients with traumatic intracranial haemorrhage within 24 hours after blunt head injury. Br J Neurosurg. 2009;23:617–21.CrossRefGoogle Scholar
  37. 37.
    Chao A, Pearl J, Perdue P, et al. Utility of routine serial computed tomography for blunt intracranial injury. J Trauma. 2001;51:870–5.CrossRefGoogle Scholar
  38. 38.
    Kaups KL, Davis JW, Parks SN. Routinely repeated computed tomography after blunt head trauma: does it benefit patients? The Journal of trauma. 2004;56:475–80.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity of LübeckLübeckGermany

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