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

Carrera, Emmanuel and Steiner, Luzius A. and Castellani, Gianluca and Smielewski, Peter and Zweifel, Christian and Haubrich, Christina and Pickard, John D. and Menon, David K. and Czosnyka, Marek. (2011) Changes in cerebral compartmental compliances during mild hypocapnia in patients with traumatic brain injury. Journal of neurotrauma, Vol. 28, H. 6. pp. 889-896.

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Official URL: http://edoc.unibas.ch/dok/A6003388

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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.
Faculties and Departments:03 Faculty of Medicine > Bereich Querschnittsfächer (Klinik) > Anästhesiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Querschnittsfächer (Klinik) > Anästhesiologie
UniBasel Contributors:Steiner, Luzius A.
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Mary Ann Liebert
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:27 Feb 2014 15:45
Deposited On:27 Feb 2014 15:45

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