Short-term moderate hypocapnia augments detection of optimal cerebral perfusion pressure

• Verfasst von: Haubrich, Christina [VerfasserIn]
• Verfasst von: Steiner, Luzius [VerfasserIn]
• Verfasst von: Kasprowicz, Magdalena [VerfasserIn]
• Verfasst von: Diedler, Jennifer [VerfasserIn]
• Verfasst von: Carrera, Emmanuel [VerfasserIn]
• Verfasst von: Diehl, Rolf Roland [VerfasserIn]
• Verfasst von: Smielewski, Piotr [VerfasserIn]
• Verfasst von: Czosnyka, Marek [VerfasserIn]
• Titel: Short-term moderate hypocapnia augments detection of optimal cerebral perfusion pressure
• Verf.angabe: Christina Haubrich, Luzius Steiner, Magdalena Kasprowicz, Jennifer Diedler, Emmanuel Carrera, Rolf R. Diehl, Piotr Smielewski, and Marek Czosnyka
• E-Jahr: 2011
• Jahr: 18 Jul 2011
• Umfang: 5 S.
• Fussnoten: Gesehen am 31.08.2022
• Titel Quelle: Enthalten in: Journal of neurotrauma
• Ort Quelle: Larchmont, NY : Liebert, 1988
• Jahr Quelle: 2011
• Band/Heft Quelle: 28(2011), 7, Seite 1133-1137
• ISSN Quelle: 1557-9042
• DOI: doi:10.1089/neu.2010.1577
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: cerebral autoregulation
• Sach-SW: cerebral blood flow
• Sach-SW: CPP
• Sach-SW: intracranial pressure
• Sach-SW: multimodal monitoring
• Sach-SW: TBI
• K10plus-PPN: 181546822X

Abstract

An autoregulation-oriented strategy has been proposed to guide neurocritical therapy toward the optimal cerebral perfusion pressure (CPPOPT). The influence of ventilation changes is, however, unclear. We sought to find out whether short-term moderate hypocapnia (HC) shifts the CPPOPT or affects its detection. Thirty patients with traumatic brain injury (TBI), who required sedation and mechanical ventilation, were studied during 20 min of normocapnia (5.1±0.4 kPa) and 30 min of moderate HC (4.4±3.0 kPa). Monitoring included bilateral transcranial Doppler of the middle cerebral arteries (MCA), invasive arterial blood pressure (ABP), and intracranial pressure (ICP). Mx -autoregulatory index provided a measure for the CPP responsiveness of MCA flow velocity. CPPOPT was assessed as the CPP at which autoregulation (Mx) was working with the maximal efficiency. - - During normocapnia, CPPOPT (left: 80.65±6.18; right: 79.11±5.84 mm Hg) was detectable in 12 of 30 patients. Moderate HC did not shift this CPPOPT but enabled its detection in another 17 patients (CPPOPT left: 83.94±14.82; right: 85.28±14.73 mm Hg). The detection of CPPOPT was achieved via significantly improved Mx-autoregulatory index and an increase of CPP mean. It appeared that short-term moderate HC augmented the detection of an optimum CPP, and may therefore usefully support CPP-guided therapy in patients with TBI.