Portable head CT scan and its effect on intracranial pressure, cerebral perfusion pressure, and brain oxygen

Clinical article

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  • 1 Departments of Neurosurgery,
  • 2 Neurology,
  • 3 Anesthesiology and Critical Care,
  • 4 Nursing, and
  • 5 Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Object

Follow-up head CT scans are important in neurocritical care but involve intrahospital transport that may be associated with potential hazards including a deleterious effect on brain tissue oxygen pressure (PbtO2). Portable head CT (pHCT) scans offer an alternative imaging technique without a need for patient transport. In this study, the investigators examined the effects of pHCT scans on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and PbtO2 in patients with severe brain injury.

Methods

Fifty-seven pHCT scans were obtained in 34 patients (mean age of 42 ± 15 years) who underwent continuous ICP, CPP, and PbtO2 monitoring in the neuro intensive care unit at a university-based Level I trauma center. Patient ICU records were retrospectively reviewed and physiological data obtained during the 3 hours before and after pHCT scans were examined.

Results

Before pHCT, the mean ICP and CPP were 14.3 ± 7.4 and 78.9 ± 20.2 mm Hg, respectively. Portable HCT had little effect on ICP (mean ICP 14.1 ± 6.6 mm Hg, p = 0.84) and CPP (mean CPP 81.0 ± 19.8 mm Hg, p = 0.59). The mean PbtO2 was similar before and after pHCT (33.2 ± 17.0 mm Hg and 31.6 ± 15.9 mm Hg, respectively; p = 0.6). Ten episodes of brain hypoxia (PbtO2 < 15 mm Hg) were observed before pHCT; these episodes prompted scans. Brain hypoxia persisted in 5 patients after pHCT despite treatment. No new episodes of brain hypoxia were observed during or after pHCT.

Conclusions

These data suggest that pHCT scans do not have a detectable effect on a critically ill patient's ICP, CPP, or PbtO2.

Abbreviations used in this paper: CPP = cerebral perfusion pressure; GCS = Glasgow Coma Scale; ICP = intracranial pressure; NICU = neuro intensive care unit; PbtO2 = brain tissue oxygen pressure; pHCT = portable head CT; SAH = subarachnoid hemorrhage; TBI = traumatic brain injury.

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Contributor Notes

Address correspondence to: Peter D. Le Roux, M.D., Department of Neurosurgery, University of Pennsylvania, 330 South 9th Street, Philadelphia, Pennsylvania 19107. email: lerouxp@uphs.upenn.edu.

Please include this information when citing this paper: published online December 17, 2010; DOI: 10.3171/2010.11.JNS091148.

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