2022-03-082022-03-082008-12Kocaeli, H. vd. (2008). ''Analysis of intracranial pressure changes during early versus late percutaneous tracheostomy in a neuro-intensive care unit''. Acta Neurochirurgica, 150(12), 1263-1267.0001-6268https://doi.org/10.1007/s00701-008-0153-9https://link.springer.com/article/10.1007/s00701-008-0153-9http://hdl.handle.net/11452/24904Background We aimed to investigate intracranial pressure (ICP) changes during early versus late bedside percutaneous tracheostomy (PT) in a neuro-intensive care unit (NICU). Methods This study included 30 patients admitted to our NICU for head trauma, subarachnoid haemorrhage, intracerebral haematoma or brain tumour with a Glasgow Coma Score (GCS) less than 8. These patients also underwent ICP monitoring. Bedside PT was performed either early (within 7 days of ventilation) or late (after 7 days of ventilation) via the Griggs system. In all patients; ICP, systemic blood pressure, heart rate, oxygen saturation (Sat O(2)) and arterial blood gases were recorded 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure. Findings Thirty patients, 18 male and 12 female, with various intracranial pathologies between ages 18 and 78 (mean 38.7 +/- 20) were identified. The admission GCS ranged between 4 and 11 (median 7). Physiological variables did not differ significantly between the two groups. In the early group, ICP values measured 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure were 15.1 +/- 5.2, 22 +/- 10.1, 28.4 +/- 13.7, 17.3 +/- 7.1, 13.8 +/- 5.0 mmHg, respectively. In the late group, these values were 14.2 +/- 4.5, 17.2 +/- 5.5, 21.5 +/- 8.0, 15.1 +/- 5.3 and 12.4 +/- 4.1 mmHg. There was no significant difference between the early or late groups in terms of ICP increases during these predetermined 5 time points. Conclusions In patients with decreased intracranial compliance, a relatively minimally invasive procedure such as PT may lead to significant increases in ICP. The timing of PT does not seem to influence ICP, mortality, pneumonia or early complications. During the PT procedure, ICP should be closely monitored and preventive strategies should be instituted in an attempt to prevent secondary insult to an already severely injured brain.eninfo:eu-repo/semantics/closedAccessGriggs systemIntracranial pressure monitoringNeurointensive care unitPercutaneous tracheostomyNeurosurgical patientsDilatational tracheostomyTracheotomyInjuryAdolescentAdultAgedAnoxiaBrain injuriesClinical protocolsComa, post-head ,injuryFemaleGlasgow coma scaleHumansHypercapniaHypertensionIntensive care unitsIntracranial HypertensionMaleMiddle agedPostoperative complicationsRespiration, artificialRespiratory insufficiencyRisk assessmentTime factorsTracheostomyTreatment outcomeYoung adultArticle0002615900000072-s2.0-57349165332126312671501219002373Clinical neurologySurgerySleep Apnea Syndromes; Polysomnography; Positive End Expiratory PressureAdolescentAdultAgedArterial gasArterial pressureArticleBrain hematomaBrain tumorCannulationClinical articleFemaleGlasgow coma scaleGriggs systemHead injuryHeart rateHumanIntensive careIntracranial pressure monitoringMaleMortalityOxygen saturationPneumoniaPriority journalSecondary preventionSubarachnoid hemorrhageTracheostomy