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Titolo:
Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study
Autore:
Lee, JH; Kelly, DF; Oertel, M; McArthur, DL; Glenn, TC; Vespa, P; Boscardin, WJ; Martin, NA;
Indirizzi:
Univ Calif Los Angeles, Div Neurosurg, Brain Injury Res Ctr, Los Angeles, CA 90095 USA Univ Calif Los Angeles Los Angeles CA USA 90095 Los Angeles, CA 90095 USA Univ Calif Los Angeles, Cerebral Blood Flow Lab, Los Angeles, CA 90095 USAUniv Calif Los Angeles Los Angeles CA USA 90095 Los Angeles, CA 90095 USA Univ Calif Los Angeles, Dept Epidemiol, Los Angeles, CA 90095 USA Univ Calif Los Angeles Los Angeles CA USA 90095 Los Angeles, CA 90095 USA Univ Calif Los Angeles, Dept Biostat, Los Angeles, CA 90095 USA Univ CalifLos Angeles Los Angeles CA USA 90095 Los Angeles, CA 90095 USA Univ Calif Los Angeles, Div Neurosurg, Ctr Hlth Sci, Los Angeles, CA 90095USA Univ Calif Los Angeles Los Angeles CA USA 90095 Los Angeles, CA 90095USA Univ Calif Los Angeles, Harbor Med Ctr, Los Angeles, CA 90024 USA Univ Calif Los Angeles Los Angeles CA USA 90024 Los Angeles, CA 90024 USA Univ Calif Los Angeles, Res & Educ Inst, Los Angeles, CA USA Univ Calif Los Angeles Los Angeles CA USA Educ Inst, Los Angeles, CA USA
Titolo Testata:
JOURNAL OF NEUROSURGERY
fascicolo: 2, volume: 95, anno: 2001,
pagine: 222 - 232
SICI:
0022-3085(200108)95:2<222:CDRPAA>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
CEREBRAL BLOOD-FLOW; TRAUMATIC BRAIN INJURY; INTRACRANIAL HYPERTENSION; AUTO-REGULATION; PROPOFOL; CIRCULATION; HUMANS; VASOREACTIVITY; VELOCITY; HYPERVENTILATION;
Keywords:
cerebral vasoreactivity; carbon dioxide reactivity; hyperventilation; intracranial hypertension; autoregulation; propofol; transcranial Doppler ultrasonography; traumatic brain injury;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
61
Recensione:
Indirizzi per estratti:
Indirizzo: Kelly, DF Univ Calif Los Angeles, Div Neurosurg, Brain Injury Res Ctr, Room 18-218A NPI,Box 957039, Los Angeles, CA 90095 USA Univ Calif Los Angeles Room 18-218A NPI,Box 957039 Los Angeles CA USA 90095
Citazione:
J.H. Lee et al., "Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study", J NEUROSURG, 95(2), 2001, pp. 222-232

Abstract

Object. Contemporary management of head-injured patients is based on assumptions about CO., reactivity, pressure autoregulation (PA), and vascular reactivity to pharmacological metabolic suppression. In this study, serial assessments of vasoreactivity of the middle cerebral artery (MCA) were per-formed using bilateral transcranial Doppler (TCD) ultrasonography. Methods. Twenty-eight patients (mean age 33 +/- 13 years, median Glasgow Coma Scale score of 7) underwent a total of 61 testing sessions during postinjury Days 0 to 13. The CO, reactivity (58 studies in 28 patients), PA (51 studies in 23 patients), and metabolic suppression reactivity (35 studies in 16 patients) were quantified for each cerebral hemisphere by measuring changes in MCA velocity in response to transient hyperventilation, arterial blood pressure elevation, or propofol-induced burst suppression, respectively. One or both hemispheres registered below normal vasoreactivity scores in40%, 69%, and 97% of study sessions for CO, reactivity, PA, and metabolic suppression reactivity (p < 0.0001), respectively. Intracranial hypertension, classified as intracranial pressure (ICP) greater than 20 mm Hg at the time of testing, was associated with global impairment of CO, reactivity, PA, and metabolic suppression reactivity (p < 0.05). A low baseline cerebral perfusion pressure (CPP) was also predictive of impaired CO, reactivity andPA (p < 0.01). Early postinjury hypotension or hypoxia was also associatedwith impaired CO, reactivity (p < 0.05), and hemorrhagic brain lesions in or overlying the MCA territory were predictive of impaired metabolic suppression reactivity (p < 0.01). The 6-month Glasgow Outcome Scale score correlated with the overall degree of impaired vasoreactivity (p < 0.05). Conclusions. During the first 2 weeks after moderate or severe head injury, CO, reactivity remains relatively intact, PA is variably impaired, and metabolic suppression reactivity remains severely impaired. Elevated ICP appears to affect all three components of vasoreactivity that were tested, whereas other clinical factors such as CPP, hypotensive and hypoxic insults, and hemorrhagic brain lesions have distinctly different impacts on the state of vasoreactivity. Incorporation of TCD ultrasonography-derived vasoreactivity data may facilitate more injury- and time-specific therapies for head-injured patients.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/11/20 alle ore 12:44:33