Trigger Characteristics of EUSIG-Defined Hypotensive Events

  • Rob Donald
  • Tim Howells
  • Ian Piper
  • I. Chambers
  • G. Citerio
  • P. Enblad
  • B. Gregson
  • K. Kiening
  • J. Mattern
  • P. Nilsson
  • A. Ragauskas
  • Juan Sahuquillo
  • R. Sinnott
  • A. Stell
Chapter
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 114)

Abstract

Background: Hypotension is a recognized ­secondary insult after traumatic brain injury (TBI). There are many definitions of hypotension, an often cited example being the Brain Trauma Foundation’s current (2007) “Guidelines for the Management of Severe Traumatic Brain Injury,” which defines hypotension as systolic pressure <90 mmHg. However, this same document declares “The importance of mean arterial pressure, as opposed to systolic pressure should also be stressed, ….” Our work shows that when using the Edinburgh University Secondary Insult Grades (EUSIG) definitions, which require monitoring of both systolic and mean arterial pressures, that most hypotensive events are in fact triggered by a breach of the mean arterial level of 70 mmHg. We suggest that close monitoring of mean arterial pressure would enable clinical teams to avoid more potentially damaging hypotensive events.

Materials and Methods: An analysis of 100 patients from the Brain-IT database was performed. Using the EUSIG definitions, 2,081 events can be obtained by analyzing the systolic and mean blood pressures on a minute by minute basis. A software program was written to identify and classify the trigger pattern for each event. A categorical analysis of these triggering patterns has been carried out.

Key Results: Our analysis shows that most events are triggered by a drop in mean arterial pressure. In fact a large number of events (91%) occur where the mean arterial pressure is below the threshold limits whereas the systolic pressure does not cross the 90 mmHg limit at all.

Conclusion: We suggest that more emphasis should be placed on closely monitoring mean arterial pressure as well as systolic pressure when trying to guard against hypotensive problems in traumatically brain injured patients. In future work we will study the underlying physiological mechanisms and attempt to further classify concomitant conditions that may be contributing to the onset of a hypotensive event.

Keywords

Traumatic Brain Injury Hypotension Systolic Arterial Blood Pressure • Mean Arterial Blood Pressure Secondary Insults 

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Copyright information

© Springer-Verlag/Wien 2012

Authors and Affiliations

  • Rob Donald
    • 1
  • Tim Howells
    • 2
  • Ian Piper
    • 3
  • I. Chambers
    • 4
  • G. Citerio
    • 5
  • P. Enblad
    • 2
  • B. Gregson
    • 6
  • K. Kiening
    • 7
  • J. Mattern
    • 7
  • P. Nilsson
    • 2
  • A. Ragauskas
    • 8
  • Juan Sahuquillo
    • 9
  • R. Sinnott
    • 10
  • A. Stell
    • 11
  1. 1.School of Mathematics and StatisticsUniversity of GlasgowGlasgow, ScotlandUK
  2. 2.Department of NeurosurgeryUppsala University HospitalUppsalaSweden
  3. 3.Department of Clinical Physics, Institute of Neurological SciencesSouthern General Hospital, 1345 Govan RoadGlasgow, ScotlandUK
  4. 4.Department of Medical PhysicsJames Cook University HospitalMiddlesbroughUK
  5. 5.NeurorianimazioneHospital San GerardoMonzaItaly
  6. 6.Department of Regional Medical PhysicsNewcastle General HospitalNewcastleUK
  7. 7.Department of NeurosurgeryRuprecht-Karls-Universitat HospitalHeidelbergGermany
  8. 8.Head of Telematics (Biomedical) Sc. Lab.Kaunas University of TechnologyKaunasLithuania
  9. 9.Department of NeurosurgeryVall d’Hebron University HospitalBarcelonaSpain
  10. 10.Department of Information SystemsUniversity of MelbourneMelbourneAustralia
  11. 11.National eScience CentreUniversity of GlasgowGlasgow, ScotlandUK

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