Abstract
The purpose of the study: to study hemodynamic parameters and the degree of its orthostatic stability during verticalization in patients with long-term impairment of consciousness in post-comatose period of brain damage.Materials and methods. This study included 30 patients with long-term impairment of consciousness caused by severe brain damage (Group 1), 10 of whom were in a vegetative state (VS) and 20 patients had a minimally conscious state (MCS). A severe traumatic brain injury was the most frequent cause of long-term disorders of consciousness (53.3%), other causes were associated with severe disorders of cerebral circulation (13.4%) and following consequences: rupture of cerebral aneurysms (10%), or post-hypoxic brain damage (10%), or removal of brain tumors (13.3%). The second group was comprised of 24 patients with local neurological symptoms after cerebral circulation disorders. The third group included 40 healthy volunteers. Systemic hemodynamic parameters were monitored using a multifunctional monitor TFM 3040i (CNSystem Austria) . Blood pressure (BP), heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) were measured in real time. The statistical analysis was carried out using the Statistica-10 software package.Results. 26 patients of the first group (86%) demonstrated satisfactory hemodynamic stability in the tilt test at 30° and 60°; 3 patients of this group presented signs of orthostatic hypotension and 1 patient developed postural orthostatic tachycardia syndrome (SPOT) when tilted by 30°. A comparative analysis of hemodynamic parameters in patients of the first and second groups did not demonstrate significant differences, except for significantly higher HR values and lower SV values in the first group. Parameters of systemic hemodynamics in the horizontal position were significantly different in healthy volunteers, and were characterized by higher SV and CO values and lower BP, HR and TPR values as compared to patients of groups 1 and 2.Conclusion. This study demonstrated a hypokinetic type of blood circulation in all patients with brain lesions; it was more severe in patients with long-term impaired consciousness after severe brain damage. The majority of patients in this group presented satisfactory orthostatic hemodynamic stability; different types of orthostatic disorders were found in 14% of cases. A passive orthostatic test (0—30—60°) applied in this study allowed to diagnose orthostatic disorders at a slight tilt up to the onset of clinical symptoms of brain hypoperfusion. This indicates the need for hemodynamic monitoring in the early stages of patients' verticalization.
Highlights
Traumatic and non-traumatic brain injuries are accompanied by disorders of consciousness and require intensive therapy in intensive care units
In patients with brain damage accompanied by varying degrees of impairment of consciousness, orthostatic hypotension is often observed during the verticalization [6], which makes passive orthostatic test
Higher stroke output (SO) and cardiac output (CO) values and lower SBP, DBP, heart rate (HR), total peripheral resistance (TPR) were found in healthy subjects compared to patients
Summary
Traumatic and non-traumatic brain injuries are accompanied by disorders of consciousness and require intensive therapy in intensive care units. Severe traumatic brain injury is the most common cause of such brain damage Such injuries are observed in 40 patients per 100,000 population [1]. It should be noted that patient’s verticalization cannot be directly understood as the transfer of patients from the horizontal to the vertical position This term is proposed to describe the process or technique of restoring patient's ability to maintain systemic hemodynamics at a stable level in the vertical position [5]. Even in healthy individuals, prolonged bed rest causes rapid development of muscle atrophy and orthostatic hemodynamic disorders in the form of orthostatic hypotension [2]. In patients with brain damage accompanied by varying degrees of impairment of consciousness, orthostatic hypotension is often observed during the verticalization [6], which makes passive orthostatic test
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