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Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
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2017 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, 50Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. METHODS: A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. RESULTS: Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. CONCLUSIONS: Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

Place, publisher, year, edition, pages
BioMed Central, 2017. Vol. 25, 50
Keyword [en]
Air ambulance, Intracranial pressure, Pneumocephalus
National Category
Anesthesiology and Intensive Care Neurosciences Surgery Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:umu:diva-134974DOI: 10.1186/s13049-017-0394-9ISI: 000401225800001PubMedID: 28499454OAI: oai:DiVA.org:umu-134974DiVA: diva2:1095495
Available from: 2017-05-15 Created: 2017-05-15 Last updated: 2017-06-19Bibliographically approved

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Brändström, HelgeSundström, NinaJohansson, GöranWinsö, OlaKoskinen, Lars-OweHaney, Michael
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AnaesthesiologyDepartment of Radiation SciencesDiagnostic RadiologyClinical Neuroscience
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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Anesthesiology and Intensive CareNeurosciencesSurgeryRadiology, Nuclear Medicine and Medical Imaging

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