Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates*

Coles, Jonathan P.; Minhas, Pawan Singh; Fryer, Tim D.; Smielewski, Peter; Aigbirihio, Franklin I.; Donovan, Tim; Downey, S.P.M.J.; Williams, Guy B.; Chatfield, Dot; Matthews, Julian C.; Gupta, Arun Kumar; Carpenter, T. Adrian; Clark, John C.; Pickard, John D.; Menon, David

doi:10.1097/00003246-200209000-00002

Cited by 267 publications

(128 citation statements)

References 45 publications

(95 reference statements)

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“…Most guidelines focus on ICP control as a means to maintain adequate CPP. 34 Current medical treatments to reduce ICP include hyperosmolar therapy (such as mannitol or hypertonic saline), 53 hyperventilation, 15,47 sedation and paralytics, and head of bed elevation. In addition, barbiturate-induced coma 2 and hypothermia 7 have been shown to reduce cerebral metabolic rate and oxygen demands, offering a protective role.…”

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

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Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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“…Adult TBI studies demonstrate that CBF reduction early after injury increases regional cerebral ischemia [68,69]. However, decrease in CBF may not be problematic if, following TBI, baseline CMRO 2 is low and there is a compensatory increase in oxygen extraction fraction [70].…”

Section: Cerebrovascular Physiology After Tbi Altered Cerebral Blood mentioning

confidence: 99%

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Udomphorn

Armstead

Vavilala

2008

Pediatric Neurology

132

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Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Cerebral autoregulation is often impaired following traumatic brain injury and may adversely impact poor outcome. Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. In this article, we discuss normal pediatric cerebral physiology and cerebrovascular pathophysiology following pediatric traumatic brain injury.

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“…Disturbances in cerebral blood flow (CBF are also a common sequela of head injury and have been documented both experimentally (Yamakami and McIntosh, 1991;Bryan et al, 1995;Kochanek et al, 1995;Forbes et al, 1997;Hendrich et al, 1999;Lythgoe et al, 2003) and clinically (Bouma et al, 1991;Marion et al, 1991;Martin et al, 1997;Coles et al, 2002). CBF abnormalities have been shown to be an important mechanism underlying secondary brain damage experimentally (Jenkins et al, 1989;Giri et al, 2000) and clinically have been shown to be strongly associated with poor outcome (Robertson et al, 1992).…”

mentioning

confidence: 99%

Relationship between Flow-Metabolism Uncoupling and Evolving Axonal Injury after Experimental Traumatic Brain Injury

Chen

Richards

Smielewski

et al. 2004

J Cereb Blood Flow Metab

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Summary: Blood flow-metabolism uncoupling is a welldocumented phenomenon after traumatic brain injury, but little is known about the direct consequences for white matter. The aim of this study was to quantitatively assess the topographic interrelationship between local cerebral blood flow (LCBF) and glucose metabolism (LCMRglc) after controlled cortical impact injury and to determine the degree of correspondence with the evolving axonal injury. LCMRglc and LCBF measurements were obtained at 3 hours in the same rat from 18 Ffluorodeoxyglucose and 14 C-iodoantipyrine coregistered autoradiographic images, and compared to the density of damaged axonal profiles in adjacent sections and in an additional group at 24 hours using beta-amyloid precursor protein (ß-APP) immunohistochemistry. LCBF was significantly reduced over the ipsilateral hemisphere by 48 ± 15% compared with shamcontrols, whereas LCMRglc was unaffected, apart from foci of elevated LCMRglc in the contusion margin. Flow-metabolism was uncoupled, indicated by a significant 2-fold elevation in the LCMRglc/LCBF ratio within most ipsilateral structures. There was a significant increase in ß-APP-stained axons from 3 to 24 hours, which was negatively correlated with LCBF and positively correlated with the LCMRglc/LCBF ratio at 3 hours in the cingulum and corpus callosum. Our study indicates a possible dependence of axonal outcome on flow-metabolism in the acute injury stage.

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Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates*

Cited by 267 publications

References 45 publications

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Relationship between Flow-Metabolism Uncoupling and Evolving Axonal Injury after Experimental Traumatic Brain Injury

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