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Intracranial pressure during hemodialysis in patients with acute brain injury

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@article{36221646ca7a4e708ca047896324aab3,
title = "Intracranial pressure during hemodialysis in patients with acute brain injury",
abstract = "BACKGROUND: Because osmotic fluid shifts may occur over the blood-brain barrier, patients with acute brain injury are theoretically at risk of surges in intracranial pressure (ICP) during hemodialysis. However, this remains poorly investigated. We studied changes in ICP during hemodialysis in such patients.METHODS: We performed a retrospective study of patients with acute brain injury admitted to Rigshospitalet (Copenhagen, Denmark) from 2012 to 2016 who received intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) while undergoing ICP monitoring. Data from each patient's first dialysis session were collected. Area under the curve divided by time (AUC/t) for ICP was calculated separately before and during dialysis.RESULTS: Thirteen patients were included. During dialysis, ICP increased from a baseline of 11.9 mm Hg (median; interquartile range 6.3-14.7) to a maximum of 21 mm Hg (18-27) (P = 0.0024), and AUC/t for ICP was greater during dialysis (15.2 (13.4-18.8) vs 11.7 mm Hg (6.4-15.1), P = 0.042). The maximum ICP increase was independent of dialysis modality, but peak values were reached earlier in patients treated with IHD (N = 4) compared to CRRT (N = 9) (75 [30-90] vs 375 min [180-420] after start of treatment, P = 0.0095). The maximum ICP increase correlated positively to the baseline plasma urea concentration (Spearman's r = 0.69, P = 0.017).CONCLUSION: Hemodialysis is associated with increased ICP in neurocritically ill patients, and the magnitude of the increase may be related to initial plasma urea levels.",
keywords = "acute brain injury, cerebral edema, continuous renal replacement therapy, dialysis disequilibrium syndrome, hemodialysis, intracranial pressure, renal replacement therapy",
author = "Anton Lund and Damholt, {Mette B} and J{\o}rgen Wiis and Jesper Kelsen and Strange, {Ditte G} and Kirsten M{\o}ller",
note = "{\circledC} 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",
year = "2019",
month = "4",
day = "1",
doi = "10.1111/aas.13298",
language = "English",
volume = "63",
pages = "493--499",
journal = "Acta Anaesthesiologica Scandinavica",
issn = "0001-5172",
publisher = "Wiley-Blackwell Munksgaard",
number = "4",

}

RIS

TY - JOUR

T1 - Intracranial pressure during hemodialysis in patients with acute brain injury

AU - Lund, Anton

AU - Damholt, Mette B

AU - Wiis, Jørgen

AU - Kelsen, Jesper

AU - Strange, Ditte G

AU - Møller, Kirsten

N1 - © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - BACKGROUND: Because osmotic fluid shifts may occur over the blood-brain barrier, patients with acute brain injury are theoretically at risk of surges in intracranial pressure (ICP) during hemodialysis. However, this remains poorly investigated. We studied changes in ICP during hemodialysis in such patients.METHODS: We performed a retrospective study of patients with acute brain injury admitted to Rigshospitalet (Copenhagen, Denmark) from 2012 to 2016 who received intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) while undergoing ICP monitoring. Data from each patient's first dialysis session were collected. Area under the curve divided by time (AUC/t) for ICP was calculated separately before and during dialysis.RESULTS: Thirteen patients were included. During dialysis, ICP increased from a baseline of 11.9 mm Hg (median; interquartile range 6.3-14.7) to a maximum of 21 mm Hg (18-27) (P = 0.0024), and AUC/t for ICP was greater during dialysis (15.2 (13.4-18.8) vs 11.7 mm Hg (6.4-15.1), P = 0.042). The maximum ICP increase was independent of dialysis modality, but peak values were reached earlier in patients treated with IHD (N = 4) compared to CRRT (N = 9) (75 [30-90] vs 375 min [180-420] after start of treatment, P = 0.0095). The maximum ICP increase correlated positively to the baseline plasma urea concentration (Spearman's r = 0.69, P = 0.017).CONCLUSION: Hemodialysis is associated with increased ICP in neurocritically ill patients, and the magnitude of the increase may be related to initial plasma urea levels.

AB - BACKGROUND: Because osmotic fluid shifts may occur over the blood-brain barrier, patients with acute brain injury are theoretically at risk of surges in intracranial pressure (ICP) during hemodialysis. However, this remains poorly investigated. We studied changes in ICP during hemodialysis in such patients.METHODS: We performed a retrospective study of patients with acute brain injury admitted to Rigshospitalet (Copenhagen, Denmark) from 2012 to 2016 who received intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) while undergoing ICP monitoring. Data from each patient's first dialysis session were collected. Area under the curve divided by time (AUC/t) for ICP was calculated separately before and during dialysis.RESULTS: Thirteen patients were included. During dialysis, ICP increased from a baseline of 11.9 mm Hg (median; interquartile range 6.3-14.7) to a maximum of 21 mm Hg (18-27) (P = 0.0024), and AUC/t for ICP was greater during dialysis (15.2 (13.4-18.8) vs 11.7 mm Hg (6.4-15.1), P = 0.042). The maximum ICP increase was independent of dialysis modality, but peak values were reached earlier in patients treated with IHD (N = 4) compared to CRRT (N = 9) (75 [30-90] vs 375 min [180-420] after start of treatment, P = 0.0095). The maximum ICP increase correlated positively to the baseline plasma urea concentration (Spearman's r = 0.69, P = 0.017).CONCLUSION: Hemodialysis is associated with increased ICP in neurocritically ill patients, and the magnitude of the increase may be related to initial plasma urea levels.

KW - acute brain injury

KW - cerebral edema

KW - continuous renal replacement therapy

KW - dialysis disequilibrium syndrome

KW - hemodialysis

KW - intracranial pressure

KW - renal replacement therapy

U2 - 10.1111/aas.13298

DO - 10.1111/aas.13298

M3 - Journal article

VL - 63

SP - 493

EP - 499

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 4

ER -

ID: 55811912