The aim of this proposal is to evaluate, in the context of optimal medical management of cerebrovascular dynamics, the impact of a bedside system of cerebral perfusion pressure (CPP) information feedback on nursing moment-to-moment management of CPP, and the relationship of that management to patient functional outcome at discharge 3 and 6 months. Prevention or reduction of secondary brain injury is a key component of critical care management for patients with a variety of brain insults. Current clinical management emphasizes maintaining COO at or above 70mm Hg to minimize such secondary injury. However, due to poor ergonomics in clinical monitoring displays, it is likely that short episodes of decreased CPP are missed by attending nurses in the course of necessary patient repositioning, suctioning, and other routine therapeutic activities. Given the crucial role of neuronal perfusion in preventing secondary injury, beyond that of the original brain insult, refining the nurse~s ability to visualize and manage CPP on a moment-to-moment basis may allow measurable improvement in short and long-term patient functional outcome. Computer interfaces that provide visual information about CPP will be randomly allocated to beds in each of the 3 intensive care units used for patients with closed head injury or subarachnoid hemorrhage, in whom ICP monitors and arterial lines have been placed for medical management, stratified by primary diagnosis (CHI or SAH) and severity. Continuous data will be collected from 150 patients with 150 patients without the interface monitor for the duration of CPP monitoring, The primary hypothesis being tested are that Glasgow Outcome Score (GOS) 6 months post acute care discharge will be significantly better in those monitored with the continuous CPP display. Secondary endpoints are GOS at discharge and 3 months post discharge, Functional Independence Measure (FIM) score at discharge, 3 and 6 months, Process endpoint is the percentage of CPP below 70mm Hg during hospital monitoring, and the rate of cerebral oxygen desaturation during monitoring

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
1R01NR004901-01
Application #
2824746
Study Section
Nursing Research Study Section (NURS)
Program Officer
Bryan, Yvonne E
Project Start
1999-04-01
Project End
2002-03-31
Budget Start
1999-04-01
Budget End
2000-03-31
Support Year
1
Fiscal Year
1999
Total Cost
Indirect Cost
Name
University of Washington
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
Thompson, Hilaire J; Kirkness, Catherine J; Mitchell, Pamela H (2010) Hypothermia and rapid rewarming is associated with worse outcome following traumatic brain injury. J Trauma Nurs 17:173-7
Fan, Jun-Yu; Kirkness, Catherine; Vicini, Paolo et al. (2010) An approach to determining intracranial pressure variability capable of predicting decreased intracranial adaptive capacity in patients with traumatic brain injury. Biol Res Nurs 11:317-24
Kirkness, Catherine J; Burr, Robert L; Mitchell, Pamela H (2009) Intracranial and blood pressure variability and long-term outcome after aneurysmal sub-arachnoid hemorrhage. Am J Crit Care 18:241-51
Kirkness, Catherine J; Burr, Robert L; Cain, Kevin C et al. (2008) The impact of a highly visible display of cerebral perfusion pressure on outcome in individuals with cerebral aneurysms. Heart Lung 37:227-37
Fan, Jun-Yu; Kirkness, Catherine; Vicini, Paolo et al. (2008) Intracranial pressure waveform morphology and intracranial adaptive capacity. Am J Crit Care 17:545-54
Burr, Robert L; Kirkness, Catherine J; Mitchell, Pamela H (2008) Detrended fluctuation analysis of intracranial pressure predicts outcome following traumatic brain injury. IEEE Trans Biomed Eng 55:2509-18
Kirkness, Catherine J; Burr, Robert L; Mitchell, Pamela H (2008) Intracranial pressure variability and long-term outcome following traumatic brain injury. Acta Neurochir Suppl 102:105-8
Kirkness, Catherine J; Burr, Robert L; Thompson, Hilaire J et al. (2008) Temperature rhythm in aneurysmal subarachnoid hemorrhage. Neurocrit Care 8:380-90
Thompson, Hilaire J; Kirkness, Catherine J; Mitchell, Pamela H (2007) Intensive care unit management of fever following traumatic brain injury. Intensive Crit Care Nurs 23:91-6
Kirkness, Catherine J; Burr, Robert L; Cain, Kevin C et al. (2006) Effect of continuous display of cerebral perfusion pressure on outcomes in patients with traumatic brain injury. Am J Crit Care 15:600-9; quiz 610

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