The prognostic and therapeutic importance of changes in the CSF during the acute stage of brain injury

Abstract

This research deals with the gaseous and biochemical changes in the cerebrospinal fluid and their effects on the cerebral blood flow and metabolic rates in the acute stage of brain injury. The results have shown that the lactacidosis in the CSF is of importance for prognosis and therapy, because of its central position in the course of pathophysiological mechanisms after a traumatic brain injury. Thus the lactate concentration in the CSF does give early information about the further clinical course. CSF acidosis itself can be influenced in a favourable way by intrathecal therapy with sodium bicarbonate.

Cerebral energy failure after subarachnoid hemorrhage: The role of relative hyperglycolysis

“…One paper showed that CMRO 2 increased and ICP decreased once cerebral acidosis was at least partially reversed after an administration of sodium bicarbonate into the cerebral ventricles. 29 Others have reported the intravenous use of tromethamine (THAM) buffer to treat elevated ICP. [30][31][32] Although it was not entirely clear as to why THAM buffer worked, its use was recommended.…”

“…In the older literature where patients were not routinely intubated and ICUs were not well equipped compared to current standards, there were reports of hyperventilation in patients breathing spontaneously after TBI. 29 Since hyperventilation causes respiratory alkalosis, it could be speculated that those patients buffered their cerebral acidosis by increasing their blood pH to restore cerebral metabolism. One paper showed that CMRO 2 increased and ICP decreased once cerebral acidosis was at least partially reversed after an administration of sodium bicarbonate into the cerebral ventricles.…”

Control of Carbon Dioxide Levels during Neuroanaesthesia: Current Practice and an Appraisal of our Reliance upon Capnography

“…However, their numbers were small (n = 11), CSF or brain pHs were not measured, and the authors admitted that their hypotheses were "highly speculative". Intrathecal bicarbonate 64 and alkalising drugs 62 may be beneficial following head injury, but like hyperventilation-induced respiratory alkalosis, the reason for this is unclear, and all three remain unproven in humans.…”

Intracranial Pressure VII

“…Sietz and coworkers used intrathecal sodium bicarbonate in patients in coma from severe head injury (Seitz and Ocker 1977). Sietz and coworkers used intrathecal sodium bicarbonate in patients in coma from severe head injury (Seitz and Ocker 1977).…”