Document Detail


The Lund concept: is this logical?
MedLine Citation:
PMID:  16463904     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The optimal therapy of sustained increase in intracranial pressure (ICP) is still controversial. The "Lund concept" is based on the physiological volume regulation of the intracranial compartments. In addition to its other functions the blood-brain barrier (BBB) is the most important regulator of brain volume. Water exchange across the intact BBB is counteracted by the low permeability to crystalloids (mainly Na+ and Cl-) combined with the high osmotic pressure (5,700 mmHg) on both sides of the BBB. If the BBB is disrupted transcapillary water transport will be determined by the differences in hydrostatic and colloid osmotic pressure between the intra- and extracapillary compartments. Under pathological conditions pressure autoregulation of cerebral blood flow is often impaired and intracapillary hydrostatic pressure will depend on variations in systemic blood pressure. The "Lund concept" can be summarized in four paragraphs: I. Reduction of stress response and cerebral energy metabolism; II. Reduction of capillary hydrostatic pressure; III. Maintenance of colloid osmotic pressure and control of fluid balance; IV. Reduction of cerebral blood volume. The efficacy of the treatment protocol has been evaluated in experimental and clinical studies regarding the physiological and biochemical (utilizing intracerebral microdialysis) effects. The clinical experiences have been favourable.
Authors:
C H Nordström
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  95     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2005  
Date Detail:
Created Date:  2006-02-08     Completed Date:  2006-03-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  475-80     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Lund University Hospital, Lund, Sweden. carl-henrik.nordstrom@neurokir.lu.se
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Volume*
Blood-Brain Barrier*
Brain / blood supply,  physiopathology
Capillary Permeability
Cerebrovascular Circulation
Energy Metabolism
Humans
Hydrostatic Pressure
Intracranial Hypertension / physiopathology*,  therapy*
Intracranial Pressure*
Models, Biological*
Osmotic Pressure
Physician's Practice Patterns
Practice Guidelines as Topic*
Water-Electrolyte Balance

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


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