Rafael LH, Hernández LA, Santana AF, Monares ZE, Rivera DE, Porcayo LS

Language: Spanish
References: 13
Page: 184-196
PDF size: 351.22 Kb.

ABSTRACT

In our environment, the intracranial compartment syndromes, the use of positive pressure with AMV, the PEEP and the thoracic compliance veil the sensitivity and specificity of the direct measurement of ICP via intraventricular catheter, that’s why the calculation of the VPIC could be a useful and practical measure for the determination of compliance and intracranial elastance.
Methods: A prospective study. We included all patients with external ventricular shunt and connected to monitor with graphical PIC. We determined the peak systolic and diastolic pressure during inspiratory phase and later during the expiratory phase and by the following formula was calculated the VPIC: VPIC (%) = 100 x [(PPmax-PPmin)/(PPmax + PPmin)/2].
After the first measurement, 5-8 ml of CSF were removed simultaneously, and the PIC, and VPIC (VPIC postsample) were measured again, and the by the equation ΔV/Ap, Ap/ΔV the intracranial compliance and elastance were calculated respectively. A descriptive analysis was performed. The statistical correlations of the variables were evaluated with a bivariate analysis with Pearson’s test and ROC curve was plotted for the discrimination of the test.
Results: We included 16 patients, 12 men (75%), the Dx were HSA Fisher IV (12), TCE (2), excision of tumor (1) and brain abscess (1), these patients underwent 26 measurements, was found a significant relationship between the VPIC postsample, compliance and intracranial elastance (p = 0.006). In a predictive analysis that was obtained the VPIC › 5% has a sensitivity of 90% for intracranial elastance (AUC: 0.927, p = 0.49) but a specificity of 10% (AUC: 0.073, p = 0.49). Similarly, ICP › 15 cm H2O has a sensitivity of 70% (AUC: 0.710 p = .189) for intracranial compliance and specificity of 30% (AUC: 0.290, p = .189) for intracranial elastance.
Conclusion: We can use the VPIC as a predictor of intracranial elastance due to its sensitivity, and a static set of monitoring such as measuring the PIC as a predictor of compliance; however it is important to note that we require more samples from patients with HEC and PIC greater than 20 mmHg.

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