Preventing intracranial pressure fluctuation in severe traumatic brain injury during hemodialysis

Shih Hao Yeh, Chen Yu Wang, Chien Min Lin

Research output: Contribution to journalArticle

Abstract

Background: Past studies have observed rises in intracranial pressure (ICP) during hemodialysis (HD) in the neurosurgical patient. This phenomenon may cause secondary brain injury and further compromise the patients’ recovery. While continuous renal replacement modalities can theoretically be more beneficial for the brain‑injured patient, this option is often not available due to limited resources. Modified prescriptions of intermittent HD may be the more easily accessible method. The purpose of this study is to clarify whether a less aggressive HD regimen in patients with severe traumatic brain injury (TBI) will prevent ICP fluctuation during HD. Patients and Methods: We present a single center experience with the enrollment of nine uremic patients with severe TBI who underwent decompressive surgery with ICP monitoring via external ventricular drain (EVD) between January 2003 and December 2006. These patients were divided into two groups based on different HD methods. In Group A, four patients received standard intermittent HD every other day, and in Group B, five patients received a modified, daily dialysis procedure that cut the amount of fluid removed per session and the dialysate flow rate by half. Results: All patients in both groups experienced an increased ICP during HD, but milder ICP changes were found in all five patients (P < 0.05) who had received the modified procedure (Group B). All patients in Group A had expired, but there were only two mortalities in Group B. Conclusion: ICP fluctuation may be minimalized by altering the HD protocol. A less aggressive HD procedure is recommended for uremic patients with severe TBI.

Original languageEnglish
Pages (from-to)152-157
Number of pages6
JournalJournal of Medical Sciences (Taiwan)
Volume36
Issue number4
DOIs
Publication statusPublished - Jul 1 2016

Fingerprint

Intracranial Pressure
Renal Dialysis
Traumatic Brain Injury
Dialysis Solutions
Brain Injuries
Prescriptions
Dialysis

Keywords

  • Dialysis disequilibrium syndrome
  • Increased intracranial pressure
  • Severe traumatic brain injury
  • Uremia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Preventing intracranial pressure fluctuation in severe traumatic brain injury during hemodialysis. / Yeh, Shih Hao; Wang, Chen Yu; Lin, Chien Min.

In: Journal of Medical Sciences (Taiwan), Vol. 36, No. 4, 01.07.2016, p. 152-157.

Research output: Contribution to journalArticle

@article{4f6058f476d744c2b9891e80a64555e0,
title = "Preventing intracranial pressure fluctuation in severe traumatic brain injury during hemodialysis",
abstract = "Background: Past studies have observed rises in intracranial pressure (ICP) during hemodialysis (HD) in the neurosurgical patient. This phenomenon may cause secondary brain injury and further compromise the patients’ recovery. While continuous renal replacement modalities can theoretically be more beneficial for the brain‑injured patient, this option is often not available due to limited resources. Modified prescriptions of intermittent HD may be the more easily accessible method. The purpose of this study is to clarify whether a less aggressive HD regimen in patients with severe traumatic brain injury (TBI) will prevent ICP fluctuation during HD. Patients and Methods: We present a single center experience with the enrollment of nine uremic patients with severe TBI who underwent decompressive surgery with ICP monitoring via external ventricular drain (EVD) between January 2003 and December 2006. These patients were divided into two groups based on different HD methods. In Group A, four patients received standard intermittent HD every other day, and in Group B, five patients received a modified, daily dialysis procedure that cut the amount of fluid removed per session and the dialysate flow rate by half. Results: All patients in both groups experienced an increased ICP during HD, but milder ICP changes were found in all five patients (P < 0.05) who had received the modified procedure (Group B). All patients in Group A had expired, but there were only two mortalities in Group B. Conclusion: ICP fluctuation may be minimalized by altering the HD protocol. A less aggressive HD procedure is recommended for uremic patients with severe TBI.",
keywords = "Dialysis disequilibrium syndrome, Increased intracranial pressure, Severe traumatic brain injury, Uremia",
author = "Yeh, {Shih Hao} and Wang, {Chen Yu} and Lin, {Chien Min}",
year = "2016",
month = "7",
day = "1",
doi = "10.4103/1011-4564.188900",
language = "English",
volume = "36",
pages = "152--157",
journal = "Journal of Medical Sciences",
issn = "1011-4564",
publisher = "國防醫學院",
number = "4",

}

TY - JOUR

T1 - Preventing intracranial pressure fluctuation in severe traumatic brain injury during hemodialysis

AU - Yeh, Shih Hao

AU - Wang, Chen Yu

AU - Lin, Chien Min

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background: Past studies have observed rises in intracranial pressure (ICP) during hemodialysis (HD) in the neurosurgical patient. This phenomenon may cause secondary brain injury and further compromise the patients’ recovery. While continuous renal replacement modalities can theoretically be more beneficial for the brain‑injured patient, this option is often not available due to limited resources. Modified prescriptions of intermittent HD may be the more easily accessible method. The purpose of this study is to clarify whether a less aggressive HD regimen in patients with severe traumatic brain injury (TBI) will prevent ICP fluctuation during HD. Patients and Methods: We present a single center experience with the enrollment of nine uremic patients with severe TBI who underwent decompressive surgery with ICP monitoring via external ventricular drain (EVD) between January 2003 and December 2006. These patients were divided into two groups based on different HD methods. In Group A, four patients received standard intermittent HD every other day, and in Group B, five patients received a modified, daily dialysis procedure that cut the amount of fluid removed per session and the dialysate flow rate by half. Results: All patients in both groups experienced an increased ICP during HD, but milder ICP changes were found in all five patients (P < 0.05) who had received the modified procedure (Group B). All patients in Group A had expired, but there were only two mortalities in Group B. Conclusion: ICP fluctuation may be minimalized by altering the HD protocol. A less aggressive HD procedure is recommended for uremic patients with severe TBI.

AB - Background: Past studies have observed rises in intracranial pressure (ICP) during hemodialysis (HD) in the neurosurgical patient. This phenomenon may cause secondary brain injury and further compromise the patients’ recovery. While continuous renal replacement modalities can theoretically be more beneficial for the brain‑injured patient, this option is often not available due to limited resources. Modified prescriptions of intermittent HD may be the more easily accessible method. The purpose of this study is to clarify whether a less aggressive HD regimen in patients with severe traumatic brain injury (TBI) will prevent ICP fluctuation during HD. Patients and Methods: We present a single center experience with the enrollment of nine uremic patients with severe TBI who underwent decompressive surgery with ICP monitoring via external ventricular drain (EVD) between January 2003 and December 2006. These patients were divided into two groups based on different HD methods. In Group A, four patients received standard intermittent HD every other day, and in Group B, five patients received a modified, daily dialysis procedure that cut the amount of fluid removed per session and the dialysate flow rate by half. Results: All patients in both groups experienced an increased ICP during HD, but milder ICP changes were found in all five patients (P < 0.05) who had received the modified procedure (Group B). All patients in Group A had expired, but there were only two mortalities in Group B. Conclusion: ICP fluctuation may be minimalized by altering the HD protocol. A less aggressive HD procedure is recommended for uremic patients with severe TBI.

KW - Dialysis disequilibrium syndrome

KW - Increased intracranial pressure

KW - Severe traumatic brain injury

KW - Uremia

UR - http://www.scopus.com/inward/record.url?scp=84983423791&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84983423791&partnerID=8YFLogxK

U2 - 10.4103/1011-4564.188900

DO - 10.4103/1011-4564.188900

M3 - Article

AN - SCOPUS:84983423791

VL - 36

SP - 152

EP - 157

JO - Journal of Medical Sciences

JF - Journal of Medical Sciences

SN - 1011-4564

IS - 4

ER -