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Monitoring and sedation differences in the management of severe head injury and subarachnoid hemorrhage among neurocritical care centers.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
(English)Article in journal (Refereed) Submitted
Keyword [en]
wake-up test, sedation, monitoring, traumatic brain injury, subarachnoid haemorrhage
National Category
Clinical Medicine
URN: urn:nbn:se:uu:diva-173428OAI: oai:DiVA.org:uu-173428DiVA: diva2:517522
Available from: 2012-04-24 Created: 2012-04-24 Last updated: 2012-08-01Bibliographically approved
In thesis
1. The Neurological Wake-up Test in Neurocritical Care
Open this publication in new window or tab >>The Neurological Wake-up Test in Neurocritical Care
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The neurological wake-up test, NWT, is a clinical monitoring tool that can be used to evaluate the level of consciousness in patients with traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH) during neurocritical care (NCC). Since patients with severe TBI or SAH are often treated with mechanical ventilation and sedation, the NWT requires that the continuous sedation is interrupted. However, interruption of continuous sedation may induce a stress response and the use of the NWT in NCC is controversial.

The effects of the NWT on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were evaluated in 21 patients with TBI or SAH. Compared to baseline when the patients were sedated with continuous propofol sedation, the NWT resulted in increased ICP and CPP (p<0.05). Next, the effects of the NWT on the stress hormones adrenocorticotrophic hormone (ACTH), cortisol, epinephrine and norepinephrine were evaluated in 24 patients. Compared to baseline, the NWT caused a mild stress response resulting in increased levels of all evaluated stress hormones (p<0.05). To compare the use of routine NCC monitoring tools, the choice of sedation and analgesia and the frequency of NWT in Scandinavian NCC units, a questionnaire was used. The results showed that all 16 Scandinavian NCC units routinely use ICP and CPP monitoring and propofol and midazolam were primary choices for patient sedation in an equal number of NCC units. In 2009, the NWT was not routinely used in eight NCC units whereas others used the test up to six times daily.

Finally, intracerebral microdialysis (MD), brain tissue oxygenation (PbtiO2) and jugular bulb oxygenation (SjvO2) were used in 17 TBI patients to evaluate the effect of the NWT procedure on focal neurochemistry and cerebral oxygenation. The NWT did not negatively alter interstitial markers of energy metabolism or cerebral oxygenation.

In conclusion, the NWT induced a mild stress response in patients with TBI or SAH that did not result in a detectable, significant secondary insult to the injured brain. These results suggest that the NWT may safely be used as a clinical monitoring tool in the NCC of severe TBI and SAH in a majority of patients.


Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 70 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 777
Intracranial pressure, Cerebral perfusion pressure, Propofol sedation, Wake-up test, stress hormones; intracerebral microdialysis, brain tissue oxygenation, jugular venous oxygenation
National Category
Medical and Health Sciences
Research subject
urn:nbn:se:uu:diva-172798 (URN)978-91-554-8374-6 (ISBN)
Public defence
2012-05-31, Robergsalen, ing 40, vån 4, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Available from: 2012-05-09 Created: 2012-04-16 Last updated: 2012-08-01Bibliographically approved

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