Document Detail


Changes in cerebral compartmental compliances during mild hypocapnia in patients with traumatic brain injury.
MedLine Citation:
PMID:  21204704     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The benefit of induced hyperventilation for intracranial pressure (ICP) control after severe traumatic brain injury (TBI) is controversial. In this study, we investigated the impact of early and sustained hyperventilation on compliances of the cerebral arteries and of the cerebrospinal (CSF) compartment during mild hyperventilation in severe TBI patients. We included 27 severe TBI patients (mean 39.5 ± 3.4 years, 6 women) in whom an increase in ventilation (20% increase in respiratory minute volume) was performed during 50 min as part of a standard clinical CO(2) reactivity test. Using a new mathematical model, cerebral arterial compliance (Ca) and CSF compartment compliance (Ci) were calculated based on the analysis of ICP, arterial blood pressure, and cerebral blood flow velocity waveforms. Hyperventilation initially induced a reduction in ICP (17.5 ± 6.6 vs. 13.9 ± 6.2 mmHg; p < 0.001), which correlated with an increase in Ci (r(2) = 0.213; p = 0.015). Concomitantly, the reduction in cerebral blood flow velocities (CBFV, 74.6 ± 27.0 vs. 62.9 ± 22.9 cm/sec; p < 0.001) marginally correlated with the reduction in Ca (r(2) = 0.209; p = 0.017). During sustained hyperventilation, ICP increased (13.9 ± 6.2 vs. 15.3 ± 6.4 mmHg; p < 0.001), which correlated with a reduction in Ci (r(2) = 0.297; p = 0.003), but no significant changes in Ca were found during that period. The early reduction in Ca persisted irrespective of the duration of hyperventilation, which may contribute to the lack of clinical benefit of hyperventilation after TBI. Further studies are needed to determine whether monitoring of arterial and CSF compartment compliances may detect and prevent an adverse ischemic event during hyperventilation.
Authors:
Emmanuel Carrera; Luzius A Steiner; Gianluca Castellani; Peter Smielewski; Christian Zweifel; Christina Haubrich; John D Pickard; David K Menon; Marek Czosnyka
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-04-12
Journal Detail:
Title:  Journal of neurotrauma     Volume:  28     ISSN:  1557-9042     ISO Abbreviation:  J. Neurotrauma     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-21     Completed Date:  2012-05-14     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  889-96     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Brain Injuries / complications*,  diagnosis,  pathology*
Compliance / physiology
Female
Homeostasis / physiology*
Humans
Hyperventilation / pathology,  physiopathology*
Hypocapnia / diagnosis,  etiology*,  pathology*
Intracranial Hypertension / pathology,  physiopathology*,  prevention & control
Male
Prospective Studies
Trauma Severity Indices
Grant Support
ID/Acronym/Agency:
G0600986//Medical Research Council
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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