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Case Studies

Patient: This patient was a 79 year old female with an aneurysmal subarachnoid hemorrhage.

Monitored Data: A trend display on the CNS Monitor was configured to show mean arterial blood pressure (ABP[Mean]), cerebral blood flow (Perfusion), intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygen (PbtO2), and heart rate (HR). One hour of data is displayed.

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Clinical Scenario:

  • During hospitalization, the patient began having episodes of supraventricular tachycardia (SVT) accompanied by hypotension and reduction in cerebral perfusion and PbtO2.
  • The patient's baseline physiology can been seen at the beginning of the trend display (indicated by the green arrow in Figure 1).
  • The red arrow marks the episode of SVT followed by adenosine administration.
  • Note the alterations in ABP, HR, Perfusion, PbtO2, and CPP at the time. The numeric display on the right side of the screen corresponds to the time indicated by the yellow line.
  • The blue arrow marks the normalization of intracranial dynamics after resolution of the cardiac event.

FIGURE 1: CNS Monitor display shows an episode of SVT that was treated with administration of adenosine.

Episode of SVT

Discussion:

In this case, the CNS Monitor displayed the effects of a significant cardiac event and real-time intervention on cerebral physiology. Single-variable monitoring reveals little about intracranial dynamics, but multimodal monitoring may provide opportunities for identification and intervention of significant events.

The authors of this study emphasized the criticality of capturing and storing data for retrospective analysis and interpretation. Multimodal data provided by the CNS Monitor provides a unique learning opportunity for clinicians as it reveals complex cerebral physiology.

Reference: Kim Olin, Bobby Sena, Mark Krasberg, Brittany Mead, Edwin Nemoto, Howard Yonas. University of New Mexico Hospital. August 1, 2011. Used with permission.