Continuous Regional Cerebral Cortical Blood Flow Monitoring in Head-injured Patients

Sioutos, Panayiotis J.; Orozco, Jos?? A.; Carter, L. Philip; Weinand, Martin E.; Hamilton, Allan J.; Williams, Fred C.

doi:10.1097/00006123-199505000-00009

Cited by 17 publications

(23 citation statements)

References 33 publications

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“…5,29 However, just as marked and frequent fluctuations in ICP are known to occur early after injury, so too are wide variations in CBF. 39 The temporal and regional variability in CBF makes determining its role in the evolution of intracranial hypertension difficult to ascertain, particularly when using xenon-133 or Xe-CT, which are typically performed only once per day. Modalities providing continuous measurement of CBF, or estimates of blood flow such as thermal diffusion flowmetry, transcranial Doppler, and jugular venous saturation monitoring may be more ideally suited to capturing these dynamic fluctuations and their relationship to ICP.…”

Section: Hyperemia With Intracranial Hypertension and Poor Outcome (Vmentioning

confidence: 99%

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Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome

Kelly¹,

Kordestani²,

Martin³

et al. 1996

Journal of Neurosurgery

133

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The role of posttraumatic hyperemia in the development of raised intracranial pressure (ICP) has important pathophysiological and therapeutic implications. To determine the relationship between hyperemia (cerebral blood flow (CBF) > 55 ml/100 g/minute), intracranial hypertension (ICP > 20 mm Hg), and neurological outcome, 193 simultaneous measurements of ICP and CBF (xenon-133 method) were obtained in 59 patients with moderate and severe head injury. Hyperemia was associated with an increased incidence of simultaneous intracranial hypertension compared to nonhyperemic CBF measurements (32.2% vs. 21.6%, respectively; p < 0.059). However, in 78% of blood flow studies in which ICP was greater than 20 mm Hg, CBF was less than or equal to 55 ml/100 g/minute. At least one episode of hyperemia was documented in 34% of patients, all of whom had a Glasgow Coma Scale (GCS) score of 9 or below. In 12 individuals with hyperemia without simultaneous intracranial hypertension, ICP was greater than 20 mm Hg for an average of 11 +/- 16 hours and favorable outcomes were seen in 75% of patients. In contrast, in eight individuals with hyperemia and at least one episode of hyperemia-associated intracranial hypertension, ICP was greater than 20 mm Hg for an average of 148 +/- 84 hours (p < 0.001), and a favorable outcome was seen in only one patient (p < 0.001). Compared to the remainder of the cohort, patients with hyperemia-associated intracranial hypertension were distinctive in being the youngest, exhibiting the lowest GCS scores (all < or = 6), and having the highest incidence of effaced basilar cisterns and intractable intracranial hypertension. In the majority of individuals with hyperemia-associated intracranial hypertension, their clinical profile suggests the occurrence of a severe initial insult with resultant gross impairment of metabolic vasoreactivity and pressure autoregulation. In a minority of these patients, however, high CBF may be coupled to a hypermetabolic state, given their responsiveness to metabolic suppressive therapy. In patients with hyperemia but without intracranial hypertension, elevated CBF is also likely to be a manifestation of appropriate coupling to increased metabolic demand consistent with a generally favorable outcome. This study supports the concept that there are multiple etiologies of both elevated blood flow and intracranial hypertension after head injury.

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Section: Hyperemia With Intracranial Hypertension and Poor Outcome (Vmentioning

confidence: 99%

“…Modalities providing continuous measurement of CBF, or estimates of blood flow such as thermal diffusion flowmetry, transcranial Doppler, and jugular venous saturation monitoring may be more ideally suited to capturing these dynamic fluctuations and their relationship to ICP. 1,12,19,39,40…”

Section: Hyperemia With Intracranial Hypertension and Poor Outcome (Vmentioning

confidence: 99%

Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome

Kelly¹,

Kordestani²,

Martin³

et al. 1996

Journal of Neurosurgery

133

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“…It is being used for postoperative monitoring of blood flow and for the monitoring of blood flow in arterial occlusions during operations on cerebral aneurysms 66, 67). Moreover, the continuous measurement of cortical blood flow of the brain has also been attempted in head injury cases 6s) Recently, the use of this method in head injury and aneurysm patients in intensive care units has also been reported [69][70][71][72]. This method has also been used to measure finger blood flow in experimental research in humans 56-58, v3, 74) Miyakita et al TM have observed the influence of noise, vibration and static load on peripheral circulation while healthy subjects operated a chainsaw.…”

Section: ) Clinical Application Of the Thermal Diffusion Methodsmentioning

confidence: 99%

Development of noninvasive measurement of peripheral circulation and its medical application

Nakamura

1997

Environ Health Prev Med

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Surveys were carried out on tissue blood flow measurement based on the thermal diffusion method and on the assessment of peripheral circulatory function using photosensors.Regarding the thermal diffusion method, first noninvasive measurement using a Peltier stack was carried out. Then, measurements using a thermal clearance curve at various temperatures were performed.For noninvasive measurement of the mechanical properties of peripheral arteries using photosensors, the author determined the vascular volume ratio and/or the relative vascular volume.For clinical application in field studies, it is necessary to develop an apparatus with which absolute evaluation of the intravascular volume can be carried out using the blood volume around the unit volume as an indicator. Therefore, an apparatus that removes a signal constituent from tissue other than the blood using two-wavelength photosensors is required.If a noninvasive method to accurately measure the intravascular volume is established, changes in the mechanical properties of the peripheral arteries that correspond to functional and organic changes in the normal response can be observed more directly. Moreover, quantitative assessment of peripheral circulatory function will become possible, and diagnosis of the severity of peripheral circulatory disorders will be facilitated.

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“…A minimum value of 15 ml/g/min of CBF is reliable in predicting symptomatic vasospasm 15. Continuous CBF monitoring has been used in patients with head trauma,16 SAH15 and during neurosurgical procedures 17 18. In the neurological ICU, this approach can be used to determine if flow is reduced or elevated and if cerebral autoregulation is intact or disturbed 13.…”

Section: Cerebral Blood Flow (Cbf) Monitoringmentioning

confidence: 99%

Neurointensive care biophysiological monitoring: Table 1

Dhawan

DeGeorgia

2011

J NeuroIntervent Surg

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Monitoring various physiological parameters and their derangements provides a valuable tool for management of severely brain injured patients. The various parameters and their monitoring tools include but are not all inclusive are cerebral blood flow and oxygen monitoring, jugular bulb oximetry, intracerebral microdialysis and continuous electroencephalography. It needs to be seen how these devices are applied to improve patient outcomes.

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Continuous Regional Cerebral Cortical Blood Flow Monitoring in Head-injured Patients

Cited by 17 publications

References 33 publications

Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome

Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome

Development of noninvasive measurement of peripheral circulation and its medical application

Neurointensive care biophysiological monitoring: Table 1

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