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Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients

Skoglund, Karin; Enblad, Per and Marklund, Niklas LU (2009) In Neurocritical Care 11(2). p.42-135
Abstract

OBJECTIVE: To evaluate the effects of the neurological "wake-up test" (NWT), defined as interruption of continuous propofol sedation and evaluation of the patient's level of consciousness, on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI).

METHODS: A total of 127 NWT procedures in 21 severely brain-injured adult patients with either TBI (n = 12) or SAH (n = 9) were evaluated. ICP and CPP levels prior to, during and after the NWT procedure were recorded.

RESULTS: During the NWT, ICP increased from 13.4 +/- 6 mmHg at baseline to 22.7 +/- 12 (P < 0.05) and the CPP increased from 75.6 +/- 11 to 79.1 +/- 21 mmHg (P <... (More)

OBJECTIVE: To evaluate the effects of the neurological "wake-up test" (NWT), defined as interruption of continuous propofol sedation and evaluation of the patient's level of consciousness, on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI).

METHODS: A total of 127 NWT procedures in 21 severely brain-injured adult patients with either TBI (n = 12) or SAH (n = 9) were evaluated. ICP and CPP levels prior to, during and after the NWT procedure were recorded.

RESULTS: During the NWT, ICP increased from 13.4 +/- 6 mmHg at baseline to 22.7 +/- 12 (P < 0.05) and the CPP increased from 75.6 +/- 11 to 79.1 +/- 21 mmHg (P < 0.05) in TBI patients. Eight patients showed a reduced CPP during the NWT due to increased ICP. In SAH patients, ICP increased from 10.6 +/- 5 to 16.8 +/- 8 mmHg (P < 0.05) and the CPP increased from 76.9 +/- 13 to 84.6 +/- 15 mmHg (P < 0.05).

CONCLUSION: When continuous propofol sedation was interrupted and NWT was performed in severely brain-injured patients, the mean ICP and CPP levels were modestly increased. A subset of patients showed more pronounced changes. To date, the role of the NWT in the neurointensive care of TBI and SAH patients is unclear. Although the NWT is safe in the majority of patients and may provide useful clinical information about the patient's level of consciousness, alternate monitoring methods are suggested in patients showing marked ICP and/or CPP changes during NWT.

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author
publishing date
type
Contribution to journal
publication status
published
keywords
Adolescent, Adult, Aged, Brain Injuries, Diagnostic Techniques, Neurological, Female, Humans, Hypnotics and Sedatives, Intensive Care Units, Intracranial Pressure, Male, Middle Aged, Propofol, Reaction Time, Resuscitation, Subarachnoid Hemorrhage, Time Factors, Wakefulness, Young Adult, Journal Article, Research Support, Non-U.S. Gov't
in
Neurocritical Care
volume
11
issue
2
pages
8 pages
publisher
Humana Press
external identifiers
  • scopus:70350567662
ISSN
1541-6933
DOI
10.1007/s12028-009-9255-3
language
English
LU publication?
no
id
b1f663f1-50ce-4a8b-91ba-397cd89af754
date added to LUP
2016-12-08 12:19:46
date last changed
2017-11-19 04:35:46
@article{b1f663f1-50ce-4a8b-91ba-397cd89af754,
  abstract     = {<p>OBJECTIVE: To evaluate the effects of the neurological "wake-up test" (NWT), defined as interruption of continuous propofol sedation and evaluation of the patient's level of consciousness, on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI).</p><p>METHODS: A total of 127 NWT procedures in 21 severely brain-injured adult patients with either TBI (n = 12) or SAH (n = 9) were evaluated. ICP and CPP levels prior to, during and after the NWT procedure were recorded.</p><p>RESULTS: During the NWT, ICP increased from 13.4 +/- 6 mmHg at baseline to 22.7 +/- 12 (P &lt; 0.05) and the CPP increased from 75.6 +/- 11 to 79.1 +/- 21 mmHg (P &lt; 0.05) in TBI patients. Eight patients showed a reduced CPP during the NWT due to increased ICP. In SAH patients, ICP increased from 10.6 +/- 5 to 16.8 +/- 8 mmHg (P &lt; 0.05) and the CPP increased from 76.9 +/- 13 to 84.6 +/- 15 mmHg (P &lt; 0.05).</p><p>CONCLUSION: When continuous propofol sedation was interrupted and NWT was performed in severely brain-injured patients, the mean ICP and CPP levels were modestly increased. A subset of patients showed more pronounced changes. To date, the role of the NWT in the neurointensive care of TBI and SAH patients is unclear. Although the NWT is safe in the majority of patients and may provide useful clinical information about the patient's level of consciousness, alternate monitoring methods are suggested in patients showing marked ICP and/or CPP changes during NWT.</p>},
  author       = {Skoglund, Karin and Enblad, Per and Marklund, Niklas},
  issn         = {1541-6933},
  keyword      = {Adolescent,Adult,Aged,Brain Injuries,Diagnostic Techniques, Neurological,Female,Humans,Hypnotics and Sedatives,Intensive Care Units,Intracranial Pressure,Male,Middle Aged,Propofol,Reaction Time,Resuscitation,Subarachnoid Hemorrhage,Time Factors,Wakefulness,Young Adult,Journal Article,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {2},
  pages        = {42--135},
  publisher    = {Humana Press},
  series       = {Neurocritical Care},
  title        = {Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients},
  url          = {http://dx.doi.org/10.1007/s12028-009-9255-3},
  volume       = {11},
  year         = {2009},
}