Hemodynamic Changes During Surgical Decompression in Traumatic Brain Injury Patients.
OBJECTIVE
To understand the hemodynamic changes that occur with surgical decompression of lesions caused by traumatic brain injury.


METHODS
In this prospective, observational study, patients with traumatic brain injury requiring craniotomy within 48 hours of injury were recruited. Cardiac index (CI), stroke volume index, stroke volume variation, systemic vascular resistance index (SVRI), heart rate, and mean arterial pressure were monitored throughout surgery using a FloTrac transducer. Standard anesthetic and surgical regimens were followed.


RESULTS
Hemodynamic data in 107 patients were compared before skin incision and after hematoma decompression (comparable anesthetic state). There was a significant increase in CI and stroke volume index and a decrease in SVRI and mean arterial pressure following surgical decompression. On subgroup analysis based on preincision CI, the changes were similar in patients with low and normal CI, whereas in patients with high CI, SVRI did not decrease significantly. High preincision CI with no change in SVRI with decompression was associated with poor neurologic outcome at discharge.


CONCLUSIONS
In patients with TBI, surgical decompression leads to an increase in CI and a decrease in mean arterial pressure owing to a decrease in SVRI in patients with preincision low or normal cardiac output. These changes were not seen in patients with preincision high CI, and such patients had a poor neurologic outcome.
['Bharath|Srinivasaiah|S|', 'Radhakrishnan|Muthuchellappan|M|', 'Umamaheswara Rao|Ganne Sesha|GS|']
D000293:Adolescent D000328:Adult D000368:Aged D000070642:Brain Injuries, Traumatic D019299:Decompression, Surgical D005260:Female D006439:Hemodynamics D006801:Humans D008297:Male D008875:Middle Aged D011446:Prospective Studies D055815:Young Adult
Traumatic brain injury Cardiac index FloTrac Hemodynamic variables