Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
CO2 reactivity and brain oxygen pressure monitoring in severe head injury
Autore:
Suazo, JAC; Maas, AIR; van den Brink, WA; van Santbrink, H; Steyerberg, EW; Avezaat, CJJ;
Indirizzi:
Acad Hosp, Dept Neurosurg, NL-3015 GD Rotterdam, Netherlands Acad Hosp Rotterdam Netherlands NL-3015 GD 015 GD Rotterdam, Netherlands Erasmus Univ, Dept Publ Hlth, Ctr Clin Decis Sci, Rotterdam, Netherlands Erasmus Univ Rotterdam Netherlands in Decis Sci, Rotterdam, Netherlands
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 9, volume: 28, anno: 2000,
pagine: 3268 - 3274
SICI:
0090-3493(200009)28:9<3268:CRABOP>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
CEREBRAL BLOOD-FLOW; COMATOSE PATIENTS; INTRACRANIAL HYPERTENSION; HYPERVENTILATION; MANAGEMENT; METABOLISM; GUIDELINES; SATURATION;
Keywords:
head injury; brain tissue Po-2; hyperventilation; cerebral oxygenation; arterial Pco(2); pathophysiology; ischemia; therapy; outcome; prognosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
37
Recensione:
Indirizzi per estratti:
Indirizzo: Maas, AIR Acad Hosp, Dept Neurosurg, Dr Molewaterpl 40, NL-3015 GD Rotterdam, Netherlands Acad Hosp Dr Molewaterpl 40 Rotterdam Netherlands NL-3015 GD ds
Citazione:
J.A.C. Suazo et al., "CO2 reactivity and brain oxygen pressure monitoring in severe head injury", CRIT CARE M, 28(9), 2000, pp. 3268-3274

Abstract

Objective: To investigate the effect of hyperventilation on cerebral oxygenation after severe head injury. Design:A prospective, observational study. Setting: Neurointensive care unit at a university hospital. Patients: A total of 90 patients with severe head injury (Glasgow Coma Scale score less than or equal to 8), in whom continuous monitoring of brain tissue oxygen pressure (Pbro(2)) was performed as a measure of cerebral oxygenation. Interventions: Arterial P-CO2 was decreased each day over a 5-day period for 15 mins by increasing minute volume on the ventilator setting to 20% above baseline. Arterial blood gas analysis was performed before and after changing ventilator settings. Multimodality monitoring, including Pbro(2), wasperformed in all patients. Absolute and relative Pbro(2)/Paco(2), reactivity was calculated. Outcome at 6 months was evaluated according to the Glasgow Outcome Scale. Measurements and Main Results: Effective hyperventilation, defined by a decrease of Pace, greater than or equal to 2 torr (0.27 kPa), was obtained in218 (84%) of 272 tests performed. Baseline Paco(2) averaged 32.3 +/- 4.5 torr (4.31 +/- 0.60 kPa), Average reduction in Paco(2) was 3.8 +/- 1,7 torr (0.51 +/- 0.23 kPa) Pbro(2) decreased by 2.8 +/- 3.7 torr (0.37 +/- 0.49 kPa; p < .001) from a baseline value of 26.5 +/- 11.6 torr (3.53 +/- 1.55 kPa), Pbro(2)/Paco(2) reactivity was low on day 1 (0.8 +/- 2.3 torr [0.11 +/- 0.31 kPa]), increasing on subsequent days to 6.1 +/- 4.4 torr (0.81 +/- 0.59 kPa) on day 5, Pbro(2)/Paco(2) reactivity on days 1 and 2 was not relatedto outcome, In later phases in patients with unfavorable outcome, relativereactivity was increased more markedly, reaching statistical significance on day 5,Conclusions: Increased hyperventilation causes a significant reduction in Pbro(2), providing further evidence for possible increased risk of secondary ischemic damage during hyperventilation, The low Pbro(2)/Paco(2) reactivity on day 1 indicates the decreased responsiveness of cerebral microvascular vessels to Pace, changes, caused by generalized vascular narrowing, The increasing Pbro(2)/Paco(2) reactivity from days 2 to 5 suggests that the risk of compromising cerebral oxygenation by hyperventilation may increase over time.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/11/20 alle ore 23:58:43