Orthostatic circulatory disturbances during verticalization in post-comatose patients after severe brain damages

Abstract

Objectives: Patients in the post-comatose period after critical brain damages and long-term treatment in intensive care units require special approaches to verticalization due to the risk of orthostatic circulatory disorders and deepening of ischemic processes in the brain.
 Aim: to study orthostatic disorders occurring during verticalization in patients with and without chronic consciousness disorders, after severe brain damages.
 Material and methods: 72 patients were examined during the post-comatose period, including 49 (68%) after severe stroke, 17 after severe brain injury, 3 patients with posthypoxic encephalopathy and 3 after brain tumor removal. Non-invasive registration of blood pressure (BP) in the brachial artery and monitoring beat to beat of BP was performed using Drager's bedside monitor complete with a finger sensor. Heart rate monitoring was performed automatically by computer-controlled R to R intervals in real time.
 The results: Orthostatic circulatory disorders were detected in the majority (19 out of 24) of patients with chronic consciousness impairments and in 12 out of 48 patients who were conscious. The most frequent disorder in group 1 was postural tachycardia syndrome, which was not revealed in patients of group 2. Orthostatic hypotension was observed in 25% of group 1 patients and in 20,8% of group 2 patients. Orthostatic hypertension in both groups did not exceed 10%.
 Conclusion: orthostatic circulatory disorders were revealed in 19 out of 24 patients in group 1 (79,2%) and in 25% in group 2. Application of the new protocol with real-time monitoring of BP and HR allowed to perform verticalization in all patients without complications. The structure of orthostatic circulatory disorders was established, which should be considered at the beginning of the process of verticalization of patients in the post-comatose period after severe brain damages.