Cardiopulmonary haemodynamic changes after severe head injury

Abstract

Haemodynamic studies were performed by pulmonary artery catheter in 15 patients with severe head injury. To our knowledge, few data are available about the detailed haemodynamic changes after head injury using pulmonary artery catheter. All patients were assessed by the Glasgow Coma Scale, computed tomography and intracranial pressure monitoring. We divided the patients into hypotensive and normotensive groups. All patients showed a high pulmonary vascular resistance and a high pulmonary capillary wedge pressure, probably due to pulmonary vasoconstriction. In the hypotensive group, the two major changes were a marked decrease of the cardiac index and a slight increase of systemic vascular resistance. The low cardiac index was the result of heart failure secondary to myocardial dysfunction. In contrast, the normotensive group was characterized by a high systemic vascular resistance that was induced by generalized vasoconstriction. Increased intracranial pressure is initially associated with an increase of the cardiac index and systemic vascular resistance, so patients with severe head injury also suffer from profound circulatory disturbance.

ECG Changes in 8-Year-Old Boy with Pulmonary Edema after Head Injury

“…Parallel to the ECG signs of anterolateral myocardial infarction on the second and third day of hospitalization, pathologic Q wave in leads D1 and aVL, and amputated R wave (later QS wave) in leads V2-V4, we also noticed pathologic terminal forces of P wave in lead V1 (PTF-V1) PTF-V1 > 0.4 mmsec, indicating left atrial enlargement or high diastolic pressure [5]. This coincided with the presence of hypotension on physical examination, which also confirmed the hypothesis of myocardial dysfunction as the cause of cardiac failure and pulmonary edema [4].…”

“…The rise in left atrial pressure secondary to systemic hypertension and myocardial dysfunction, due to catecholamine excess and myocitolisis, may also cause increased pulmonary capillary hydrostatic pressure [4]. In addition to echocardiography and other invasive methods revealing centrally mediated myocardial dysfunction, there are few biochemical parameters (markers of myocardial damage) proving this.…”

Myocardial function at the early phase of traumatic brain injury: a prospective controlled study

“…In our study, slight systolic and diastolic STE changes might be undermined by the early ultrasound assessment and might be significant in later examinations. Second, we do not deny the concept of acute cardiac failure following brain injuries and the hemodynamic evaluation is part of the global assessment of severity in critically ill patients [25]. Nevertheless, the concept of neurogenic cardiac failure was mainly based on different experimental models [11] such as SAH [26] or brain death.…”

Pre-ICU Management of Patients With Head Trauma

“…An increase in ICP following TBI may cause a spectrum of cardiopulmonary hemodynamic responses, including systemic hypertension and a decrease in heart rate secondary to the Cushing reflex. 10 The physiologic reactions of the circulation because of elevated ICP were first described by Dr Harvey Cushing in 1902. 2 The reflex is composed of a triad of findings: ( a ) increased systemic blood pressure, ( b ) bradycardia, and ( c ) irregular respiratory pattern.…”