Changes in cerebral compartmental compliances during mild hypocapnia in patients with traumatic brain injury.

Détails

ID Serval
serval:BIB_C00C5476920A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Changes in cerebral compartmental compliances during mild hypocapnia in patients with traumatic brain injury.
Périodique
Journal of Neurotrauma
Auteur(s)
Carrera E., Steiner L.A., Castellani G., Smielewski P., Zweifel C., Haubrich C., Pickard J.D., Menon D.K., Czosnyka M.
ISSN
1557-9042 (Electronic)
ISSN-L
0897-7151
Statut éditorial
Publié
Date de publication
01/2011
Peer-reviewed
Oui
Volume
28
Numéro
6
Pages
889-896
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
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.
Mots-clé
Adult, Brain Injuries/complications, Brain Injuries/diagnosis, Compliance/physiology, Female, Homeostasis/physiology, Humans, Hyperventilation/pathology, Hyperventilation/physiopathology, Hypocapnia/diagnosis, Hypocapnia/etiology, Intracranial Hypertension/pathology, Intracranial Hypertension/physiopathology, Male, Prospective Studies, Trauma Severity Indices
Pubmed
Web of science
Création de la notice
25/01/2011 12:42
Dernière modification de la notice
03/03/2018 21:04
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