Document Detail


Physiological and biochemical principles underlying volume-targeted therapy--the "Lund concept".
MedLine Citation:
PMID:  16174975     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The optimal therapy of sustained increase in intracranial pressure (ICP) remains controversial. The volume-targeted therapy ("Lund concept") discussed in this article focuses on the physiological volume regulation of the intracranial compartments. The balance between effective transcapillary hydrostatic and osmotic pressures constitutes the driving force for transcapillary fluid exchange. The low permeability for sodium and chloride combined with the high crystalloid osmotic pressure (approximately 5700 mmHg) on both sides of the blood-brain barrier (BBB) counteracts fluid exchange across the intact BBB. Additionally, variations in systemic blood pressure generally are not transmitted to these capillaries because cerebral intracapillary hydrostatic pressure (and blood flow) is physio-logically tightly autoregulated. Under pathophysiological conditions, the BBB may be partially disrupted. Transcapillary water exchange is then determined by the differences in hydrostatic and colloid osmotic pressure between the intra- and extracapillary compartments. Pressure autoregulation of cerebral blood flow is likely to be impaired in these conditions. A high cerebral perfusion pressure accordingly increases intracapillary hydrostatic pressure and leads to increased intracerebral water content and an increase in ICP. The volume-targeted "Lund concept" has been evaluated in experimental and clinical studies to examine the physiological and biochemical (utilizing intracerebral microdialysis) effects, and the clinical experiences have been favorable.
Authors:
Carl-Henrik Nordström
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Neurocritical care     Volume:  2     ISSN:  1541-6933     ISO Abbreviation:  Neurocrit Care     Publication Date:  2005  
Date Detail:
Created Date:  2005-09-21     Completed Date:  2005-10-27     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  83-95     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Lund University Hospital, Sweden. carl-henrik.nordstrom@neurokir.lu.se
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure / physiology
Blood Volume / physiology
Blood-Brain Barrier / physiopathology
Brain Injuries / metabolism*,  physiopathology*,  therapy
Cerebrovascular Circulation / physiology
Humans
Intracranial Pressure / physiology
Comments/Corrections
Comment In:
Neurocrit Care. 2005;2(1):3   [PMID:  16174960 ]

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


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