Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation
Abstract 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...
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doaj-a2e07f37fe554225a57f9993c0e2c89e2020-11-24T21:58:40ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412017-05-012511710.1186/s13049-017-0394-9Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulationHelge Brändström0Anna Sundelin1Daniela Hoseason2Nina Sundström3Richard Birgander4Göran Johansson5Ola Winsö6Lars-Owe Koskinen7Michael Haney8Anesthesiology and Intensive Care Medicine, Umeå UniversityAnesthesiology and Intensive Care Medicine, Umeå UniversityAnesthesiology and Intensive Care Medicine, Umeå UniversityBiomedical Engineering, Medical Radiation Sciences, Umeå UniversityRadiology, Medical Radiation Sciences, Umeå UniversityAnesthesiology and Intensive Care Medicine, Umeå UniversityAnesthesiology and Intensive Care Medicine, Umeå UniversityNeurosurgery, Pharmacology and Clinical Neurosciences, Umeå UniversityAnesthesiology and Intensive Care Medicine, Umeå UniversityAbstract 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.http://link.springer.com/article/10.1186/s13049-017-0394-9Air ambulancePneumocephalusIntracranial pressure |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Helge Brändström Anna Sundelin Daniela Hoseason Nina Sundström Richard Birgander Göran Johansson Ola Winsö Lars-Owe Koskinen Michael Haney |
spellingShingle |
Helge Brändström Anna Sundelin Daniela Hoseason Nina Sundström Richard Birgander Göran Johansson Ola Winsö Lars-Owe Koskinen Michael Haney Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Air ambulance Pneumocephalus Intracranial pressure |
author_facet |
Helge Brändström Anna Sundelin Daniela Hoseason Nina Sundström Richard Birgander Göran Johansson Ola Winsö Lars-Owe Koskinen Michael Haney |
author_sort |
Helge Brändström |
title |
Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation |
title_short |
Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation |
title_full |
Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation |
title_fullStr |
Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation |
title_full_unstemmed |
Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation |
title_sort |
risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation |
publisher |
BMC |
series |
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
issn |
1757-7241 |
publishDate |
2017-05-01 |
description |
Abstract 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. |
topic |
Air ambulance Pneumocephalus Intracranial pressure |
url |
http://link.springer.com/article/10.1186/s13049-017-0394-9 |
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