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Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study
BACKGROUND: Ambulance 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 duri...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246666/ https://www.ncbi.nlm.nih.gov/pubmed/34193207 http://dx.doi.org/10.1186/s13049-021-00904-3 |
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author | Maissan, Iscander M. Vlottes, Boris Hoeks, Sanne Bosch, Jan Stolker, Robert Jan den Hartog, Dennis |
author_facet | Maissan, Iscander M. Vlottes, Boris Hoeks, Sanne Bosch, Jan Stolker, Robert Jan den Hartog, Dennis |
author_sort | Maissan, Iscander M. |
collection | PubMed |
description | BACKGROUND: Ambulance 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. METHODS: Participants 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. RESULTS: Mean 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. CONCLUSIONS: ONSD 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. |
format | Online Article Text |
id | pubmed-8246666 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-82466662021-07-06 Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study Maissan, Iscander M. Vlottes, Boris Hoeks, Sanne Bosch, Jan Stolker, Robert Jan den Hartog, Dennis Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Ambulance 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. METHODS: Participants 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. RESULTS: Mean 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. CONCLUSIONS: ONSD 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. BioMed Central 2021-06-30 /pmc/articles/PMC8246666/ /pubmed/34193207 http://dx.doi.org/10.1186/s13049-021-00904-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Original Research Maissan, Iscander M. Vlottes, Boris Hoeks, Sanne Bosch, Jan Stolker, Robert Jan den Hartog, Dennis Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study |
title | Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study |
title_full | Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study |
title_fullStr | Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study |
title_full_unstemmed | Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study |
title_short | Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study |
title_sort | ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246666/ https://www.ncbi.nlm.nih.gov/pubmed/34193207 http://dx.doi.org/10.1186/s13049-021-00904-3 |
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