J Neurol Surg A Cent Eur Neurosurg 2017; 78(01): 42-45
DOI: 10.1055/s-0036-1592160
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Early Physiotherapy by Passive Range of Motion Does Not Affect Partial Brain Tissue Oxygenation in Neurocritical Care Patients

Christian Roth
1   Department of Neurology, Klinikum Kassel, Kassel, Germany
,
Hubertus Stitz
2   Department of Physiotherapy, Klinikum Kassel, Kassel, Germany
,
Jens Kleffmann
3   Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
,
Stefanie Kaestner
3   Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
,
Wolfgang Deinsberger
3   Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
,
Andreas Ferbert
1   Department of Neurology, Klinikum Kassel, Kassel, Germany
,
Markus Gehling
4   Department of Anesthesiology, Klinikum Kassel, Kassel, Germany
› Author Affiliations
Further Information

Publication History

09 April 2015

20 July 2016

Publication Date:
27 September 2016 (online)

Abstract

Background Studies investigating multimodal cerebral monitoring including partial brain tissue oxygen monitoring (ptiO2) in neuro-intensive care patients during physiotherapy are completely lacking in the literature.

Materials and Methods We performed a post hoc analysis of prospectively collected data of patients on multimodal cerebral monitoring by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurement as well as ptiO2. Patients with severe brain diseases were treated with passive range of motion (PROM). We recorded ICP, CPP, and ptiO2 continuously every minute at baseline (15 minutes), during treatment (26 minutes), and 15 minutes after treatment with PROM.

Results Overall, 25 treatment units with PROM in 10 patients with combined ICP/CPP and ptiO2 monitoring were evaluated. Median ICP, CPP, and ptiO2 at baseline were 12 ± 6.1 mm Hg, 86 ± 17.1 mm Hg, and 27 ± 14.3 mm Hg, respectively. Values for ICP, CPP, and ptiO2 did not change significantly when comparing mean values before, during, and after therapy.

Conclusions Based on ptiO2 measurements, our data provide new information about the feasibility and safety of physiotherapy in patients with severe brain diseases.

 
  • References

  • 1 Roth C, Stitz H, Kalhout A, Kleffmann J, Deinsberger W, Ferbert A. Effect of early physiotherapy on intracranial pressure and cerebral perfusion pressure. Neurocrit Care 2013; 18 (1) 33-38
  • 2 Koch SM, Fogarty S, Signorino C, Parmley L, Mehlhorn U. Effect of passive range of motion on intracranial pressure in neurosurgical patients. J Crit Care 1996; 11 (4) 176-179
  • 3 Brimioulle S, Moraine JJ, Norrenberg D, Kahn RJ. Effects of positioning and exercise on intracranial pressure in a neurosurgical intensive care unit. Phys Ther 1997; 77 (12) 1682-1689
  • 4 Lang EW, Jaeger M. Systemic and comprehensive literature review of publications on direct cerebral oxygenation monitoring. Open Crit Care Med J 2013; 6: 1-24
  • 5 Nortje J, Gupta AK. The role of tissue oxygen monitoring in patients with acute brain injury. Br J Anaesth 2006; 97 (1) 95-106
  • 6 Mulvey JM, Dorsch NWC, Mudaliar Y, Lang EW. Multimodality monitoring in severe traumatic brain injury: the role of brain tissue oxygenation monitoring. Neurocrit Care 2004; 1 (3) 391-402
  • 7 Bao Y, Jiang J, Zhu C, Lu Y, Cai R, Ma C. Effect of hyperventilation on brain tissue oxygen pressure, carbon dioxide pressure, pH value and intracranial pressure during intracranial hypertension in pigs. Chin J Traumatol 2000; 3 (4) 210-213
  • 8 Zauner A, Doppenberg EM, Woodward JJ, Choi SC, Young HF, Bullock R. Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 1997; 41 (5) 1082-1091 ; discussion 1091–1093
  • 9 van den Brink WA, van Santbrink H, Steyerberg EW , et al. Brain oxygen tension in severe head injury. Neurosurgery 2000; 46 (4) 868-876 ; discussion 876–878
  • 10 Sarrafzadeh AS, Kiening KL, Unterberg AW. Neuromonitoring: brain oxygenation and microdialysis. Curr Neurol Neurosci Rep 2003; 3 (6) 517-523
  • 11 Väth A, Kunze E, Roosen K, Meixensberger J. Therapeutic aspects of brain tissue pO2 monitoring after subarachnoid hemorrhage. Acta Neurochir Suppl (Wien) 2002; 81: 307-309
  • 12 Chesnut RM, Temkin N, Carney N , et al; Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367 (26) 2471-2481
  • 13 Cumming TB, Thrift AG, Collier JM , et al. Very early mobilization after stroke fast-tracks return to walking: further results from the phase II AVERT randomized controlled trial. Stroke 2011; 42 (1) 153-158