Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Iscander M. Maissan¹  Sanne Hoeks¹  Robert Jan Stolker¹  Boris Vlottes¹  Dennis den Hartog²  Jan Bosch³ 

[1] Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, Rotterdam, GD, The Netherlands;Department of Trauma Surgery, Dr. Molenwaterplein 40, 3015 GD, Rotterdam, The Netherlands;Regionale Ambulancevoorziening Hollands Midden, Research and Development, Vondellaan 43, 2332AA, Leiden, The Netherlands;

关键词: Ambulance;    Transportation;    EMS;    Traumatic brain injury;    TBI;    Intra cranial pressure;    ICP;    Optical nerve sheath diameter;    ONSD;    POCUS;    Ultrasound;   

DOI  :  10.1186/s13049-021-00904-3

来源: Springer

【 摘 要 】

BackgroundAmbulance drivers in the Netherlands are trained to drive as fluent as possible when transporting a head injured patient to the hospital. Acceleration and deceleration have the potential to create pressure changes in the head that may worsen outcome. Although the idea of fluid shift during braking causing intra cranial pressure (ICP) to rise is widely accepted, it lacks any scientific evidence. In this study we evaluated the effects of driving and deceleration during ambulance transportation on the intra cranial pressure in supine position and 30° upright position.MethodsParticipants were placed on the ambulance gurney in supine position. During driving and braking the optical nerve sheath diameter (ONSD) was measured with ultrasound. Because cerebro spinal fluid percolates in the optical nerve sheath when ICP rises, the diameter of this sheath will distend if ICP rises during braking of the ambulance. The same measurements were taken with the headrest in 30° upright position.ResultsMean ONSD in 20 subjects in supine position increased from 4.80 (IQR 4.80–5.00) mm during normal transportation to 6.00 (IQR 5.75–6.40) mm (p < 0.001) during braking. ONSD’s increased in all subjects in supine position.After raising the headrest of the gurney 30° mean ONSD increased from 4.80 (IQR 4.67–5.02) mm during normal transportation to 4.90 (IQR 4.80–5.02) mm (p = 0.022) during braking. In 15 subjects (75%) there was no change in ONSD at all.ConclusionsONSD and thereby ICP increases during deceleration of a transporting vehicle in participants in supine position. Raising the headrest of the gurney to 30 degrees reduces the effect of breaking on ICP.

【 授权许可】

CC BY