Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
Pulse and mean intracranial pressure analysis in pediatric traumatic brain injury.
We investigated the relationship between the intracranial pulse pressure (ICPpp) and the mean intracranial pressure (ICP(M)) in pediatric patients with traumatic brain injury (TBI). ⋯ Although there is an underlying linear relationship between ICPpp and ICPM, nonlinear patterns are also present. Further research is required to determine if specific nonlinear ICPpp-ICPM patterns correlate with clinically significant information.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialFuzzy pattern classification of hemodynamic data can be used to determine noninvasive intracranial pressure.
The authors previously introduced a method in which intracranial pressure (ICP) was estimated using parameters (TCD characteristics) derived from cerebral blood flow velocity (FV) and arterial blood pressure (ABP). Some results suggested that this model might be influenced by the patient's state of cerebral autoregulation and other clinical parameters. Hence, it was the aim of the present study to improve the method by modifying the previously used global procedure in certain subgroups of patients. ⋯ The class structure of the model facilitates nICP assessment in heterogeneous patient groups and supports a stepwise extension of the target patient group without affecting the former validity.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialEffects of moderate hyperventilation on cerebrovascular pressure-reactivity after head injury.
In volunteers, hyperventilation improves autoregulation. However, in head-injured patients, hyperventilation-induced deterioration and improvement of autoregulation have been reported. We have re-examined this question using an index of pressure reactivity. ⋯ This suggests that patients with disturbed pressure-reactivity may improve, whereas patients with intact pressure reactivity remain largely unchanged. Our data suggest that the response of pressure reactivity to hyperventilation is heterogeneous. This could be due to hyperventilation-induced changes in cerebral metabolism, or the change in CPP.
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Acta Neurochir. Suppl. · Jan 2005
ICM+: software for on-line analysis of bedside monitoring data after severe head trauma.
ICM software was developed in 1986 in Warsaw, Poland and has been in use at the University of Cambridge Neurocritical Care Unit for 10 years collecting data from bed-side monitors in nearly 600 severely head injured patients and calculating secondary indices describing cerebral autoregulation and pressure-volume compensation. The new software ICM+ includes a much extended calculation engine that allows easy configuration and on-line trending of complex parameters. The program records raw signals, and calculates time trends of summary parameters. ⋯ All this allows complex information coming off the bed-side monitors to be summarized in a concise fashion and presented to medical and nursing staff in a simple way that alerts them to the development of various pathological processes. The system provides a universal tool for clinical and academic purposes. Its flexibility and advanced signal processing is specialized for the needs of multidisciplinary brain monitoring.
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Acta Neurochir. Suppl. · Jan 2005
Comparative StudyEndovascular treatment for elderly patients with ruptured aneurysm.
We report our results of endovascular treatment for elderly patients with ruptured aneurysm and discuss the indication for treatment. One hundred and thirty four consecutive patients with ruptured aneurysm treated in our institute during the last 4 years were retrospectively evaluated. Fifty eight patients were included in group A (over 70 years old), and 76 patients in group B (under 69 years old). ⋯ Patients with low Hunt & Kosnik grade seem to be most suitable for endovascular treatment. On the other hand, outcome of patients with poor preoperative grade was worse despite the less invasive nature of endovascular treatment. An improvement of outcome in grade III patients is desirable.