| Cerebral blood flow and metabolism in severe brain injury: the role of pressure autoregulation during cerebral perfusion pressure management. | |
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MedLine Citation:
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PMID: 10784309 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To ascertain if norepinephrine can be used as part of the cerebral perfusion pressure (CPP) management to increase arterial blood pressure (MAP) without causing cerebral hyperemia after severe head injury (HI). DESIGN: Prospective, interventional study. SETTING: Intensive care unit in a university hospital. PATIENTS: Twelve severely HI patients; median Glasgow Coma Scale was 6 (range 3-8). INTERVENTIONS: CPP management ( = 70 mmHg). Pressure autoregulation (assessed by norepinephrine infusion) was defined intact if % CPP/%CVR < or = 2. RESULTS: Cerebral blood flow (CBF: Xe133 inhalation technique), jugular bulb oxygen saturation (SjO2) and transcranial Doppler (TCD) were recorded during the test. Norepinephrine increased CPP by 33 % (+/- 4). Autoregulation was found to be intact in ten patients and defective in two. In the ten patients with preserved autoregulation, CBF decreased from 31 +/- 3 to 28 +/- 3 ml/ 100 g/min; in the two patients with impaired autoregulation CBF increased respectively from 16 to 35 and from 21 to 70 ml/100 g/min. SjO2 did not change significantly from baseline. TCD remained within the normal range. CONCLUSIONS: During CPP management norepinephrine can be used to increase MAP without potentiating hyperemia if pressure autoregulation is preserved. The assessment of pressure autoregulation should be considered as a guide for arterial pressure-oriented therapy after HI. |
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Authors:
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L Mascia; P J Andrews; E G McKeating; M J Souter; M V Merrick; I R Piper |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Intensive care medicine Volume: 26 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 2000 Feb |
Date Detail:
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Created Date: 2000-07-20 Completed Date: 2000-07-20 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 202-5 Citation Subset: IM |
Affiliation:
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Istituto di Anestesiologia e Rianimazione, Ospedale Policlinico, Università di Bari, Italy. lmascia@teseo.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Analysis of Variance Blood Flow Velocity / drug effects, physiology Blood Pressure / drug effects, physiology Brain Injuries / drug therapy*, metabolism, physiopathology* Cerebrovascular Circulation* Female Glasgow Coma Scale Humans Infusions, Intravenous Intensive Care Units Intracranial Pressure / drug effects*, physiology Male Middle Aged Norepinephrine / administration & dosage, therapeutic use* Oxygen / metabolism Prospective Studies Ultrasonography, Doppler, Transcranial Vasoconstrictor Agents / administration & dosage, therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Vasoconstrictor Agents; 51-41-2/Norepinephrine; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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