Pulse index continuous cardiac output combined with intracranial pressure monitoring in patients with severe craniocerebral injury

Objective To explore the value of pulse index continuous cardiac output (PICCO) combined with intracranial pressure monitoring in patients with severe craniocerebral injury. Methods One hundred and thirty-eight patients with severe craniocerebral injury accepted controlling decompression surgical treatment in our hospital from February 2015 to February 2019 were prospectively chosen. According to patients' families will, postoperative application of PICCO combined with intracranial pressure monitoring for fluid management was performed in 72 patients (treatment group) and application of central venous pressure combined with intracranial pressure monitoring for fluid management was performed in 66 patients (control group). All patients were adjusted according to the monitoring results. The intracranial pressure and cerebral perfusion pressure one week after surgery, incidences of new traumatic cerebral infarction, neurogenic pulmonary edema, pulmonary infection, scalp exudation, and intracranial infection, average hospitalization days, total hospitalization costs, intensity of antimicrobial use, and Glasgow coma scale scores two weeks after operation were compared and analyzed between the two groups. Glasgow outcome scale was used to evaluate the prognoses of the patients 6 months after injury. Results There were 7 patients (3 from the control group and 4 from the treatment group) dropped out of the study due to various reasons and 131 patients (63 from the control group and 68 from the treatment group) included in the final statistical analysis; there was no significant difference in drop-out rate of the two groups (P>0.05). The intracranial pressure in the treatment group ([14.28±2.98] mmHg) was significantly lower than that in the control group ([18.99±2.78] mmHg) and cerebral perfusion pressure ([66.72±2.25] mmHg) was significantly higher than that in the control group ([52.96±3.12] mmHg) one week after operation (P<0.05). During hospitalization, the incidences of new traumatic cerebral infarction, neurogenic pulmonary edema, pulmonary infection, scalp exudation and intracranial infection in the treatment group (8.8%, 13.2%, 11.8%, 7.4%, and 2.9%) were significantly lower than those in the control group (22.2%, 27.0%, 25.4%, 19.0%, and 12.7%, P<0.05). The average hospitalization days, total hospitalization expenses and intensity of antimicrobial use in the treatment group were significantly shorter/lower than those in the control group (P<0.05). Glasgow coma scale scores (11.88±1.78) and good recovery rate (76.5%) in the treatment group were significantly higher than those in the control group (8.06±1.12, 54.0%) two weeks after operation (P<0.05). Good recovery rate (76.5%) in the treatment group was significantly higher than that in the control group (54.0%, P<0.05). The mortality rate (5.9%) was significantly lower than that in the control group (17.5%, P<0.05). Conclusion PICCO combined with intracranial pressure monitoring can effectively improve intracranial pressure, optimize cerebral perfusion, reduce complications such as traumatic cerebral infarction, neurogenic pulmonary edema, pulmonary infection and intracranial infection in patients with severe craniocerebral injury, thereby improving prognosis and reducing mortality; besides that, it can reduce patients' exposure to anti-brain infection, and the breadth and intensity of bacterial drugs can reduce the length of hospitalization and total cost of hospitalization, thereby reducing the burden of family and society. Key words: Severe craniocerebral injury; Continuous monitoring of cardiac output by pulse index; Intracranial pressure monitoring; Traumatic cerebral infarction; Neurogenic pulmonary edema; Intensity of antimicrobial use