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Original Articles
- Neurosurgery
- The RAP Index during Intracranial Pressure Monitoring as a Clinical Guiding for Surgically Treated Aneurysmal Subarachnoid Hemorrhage: Consecutive Series of Single Surgeon
- Sung-Chul Jin, Byung Sam Choi, Jung-Soo Kim
- Acute Crit Care. 2019;34(1):71-78. Published online February 28, 2019
- DOI: https://doi.org/10.4266/acc.2019.00437
- 6,524 View
- 134 Download
- 3 Web of Science
- 3 Crossref
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Abstract
PDF - Background
It is well known that assessing the RAP index along with intracranial pressure (ICP) monitoring in traumatic brain injury patients is helpful. We will discuss the usefulness of this assessment tool as a clinical guide for surgically treated poor grade aneurysmal subarachnoid hemorrhage (SAH).
Methods
This retrospective study included 35 patients with aneurysmal SAH who presented with World Federation of Neurosurgical Societies (WFNS) grade V SAH and received surgical treatment from January 2013 to December 2018. Emergency surgical clipping, hematoma removal, extraventricular drainage, and if needed, wide decompressive craniectomy were combined as the proper surgical treatments. Outcomes were assessed based on in-hospital survival and the Glasgow outcome scale score at 14-day follow-up. We compared the mortality rate of two groups of seven patients: ICP monitoring only (n=5) and ICP monitoring combined with the RAP index (n=2).
Results
The in-hospital 14-day mortality rate by brain lesion was 48.5% (n=17). Seven patients had real-time ICP monitoring. Before 2018, three of five patients with poor WFNS grade who received real-time ICP monitoring only died. There were no deaths in the group of two patients receiving real-time ICP monitoring and the RAP index.
Conclusions
Our data indicate that combining the RAP index and ICP monitoring can be used as markers for critical intracranial physiological parameters in poor grade WFNS patients. -
Citations
Citations to this article as recorded by
- Multimodal Neurologic Monitoring in Children With Acute Brain Injury
Jennifer C. Laws, Lori C. Jordan, Lindsay M. Pagano, John C. Wellons, Michael S. Wolf
Pediatric Neurology.2022; 129: 62. CrossRef - Intracranial pressure: current perspectives on physiology and monitoring
Gregory W. J. Hawryluk, Giuseppe Citerio, Peter Hutchinson, Angelos Kolias, Geert Meyfroidt, Chiara Robba, Nino Stocchetti, Randall Chesnut
Intensive Care Medicine.2022; 48(10): 1471. CrossRef - The application value of CT radiomics features in predicting pressure amplitude correlation index in patients with severe traumatic brain injury
Jiaqi Liu, Yingchi Shan, Guoyi Gao
Frontiers in Neurology.2022;[Epub] CrossRef
- Multimodal Neurologic Monitoring in Children With Acute Brain Injury
- Effect of Endotoxin on Cerebrospinal Fluid Formation in the Rat
- Dong Chan Kim, Yu Jeong Kim, Gi Chul Min
- Korean J Crit Care Med. 2001;16(1):48-54.
- 1,459 View
- 20 Download
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Abstract
PDF
- BACKGROUND
Bacterial lipopolysaccharide (LPS), an endotoxin, can increase nitric oxide (NO) production by expression of an inducible isoforms of nitric oxide synthase (iNOS). Bacterial infections of the central nervous system dilate cerebral vessels and increase cerebral blood flow. We hypothesized that systemic and intraventricular application of bacterial lipopolysaccharide would increase cerebrospinal fluid (CSF) production due to increase in blood flow to choroid plexus caused by NO-induced vasodilation.
METHODS
Ventriculocisternal perfusion was used to measure the production of CSF in pentobarbital-anesthetized rats. The lateral ventricle and cisterna magna were cannulated stereotactically and perfused continuously with artificial CSF with blue dextran 2000 as the indicator. Baseline collections of CSF began after steady state outflow was established; then, endotoxin was administered intravenously or intraventricularly. The baseline rate of CSF production was compared with that measured during 3 hours after endotoxin administration.
RESULTS
The baseline rate of CSF production was 2.6 0.3 (2.2~3.5)microliter/minute in the rat. There were no significant changes in CSF production rate after intravenous or intraventriculr administration of endotoxin.
CONCLUSIONS
We could not observe significant changes in CSF production rate with the ventriculocisternal perfusion method of measuring CSF production after intravenous or intraventriculr administration of endotoxin in the rats.
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