Brain Tissue Oxygenation and Cerebral Perfusion Pressure Thresholds of Ischemia in a Standardized Pig Brain Death Model

✓ Transcranial Doppler ultrasonography was used to monitor 71 patients suffering from intracranial hypertension with subsequent brain death. Among these, 29 patients were also assessed for systemic arterial pressure and epidural intracranial pressure, so that a correlation between cerebral perfusion pressure and the Doppler ultrasonography waveforms could be established. Four-vessel angiography was also performed in 33 patients after clinical brain death. With increasing intracranial pressure, the transcranial Doppler ultrasonography waveforms exhibited different characteristic high-resistance profiles with first low, then zero, and then reversed diastolic flow velocities, depending on the relationship between intracranial pressure and blood pressure (that is, cerebral perfusion pressure). This study shows that transcranial. Doppler ultrasonography may be used to assess the degree of intracranial hypertension. This technique further provides a practicable, noninvasive bedside monitor of therapeutic measures.

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Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure*

Critical Care Medicine ◽

10.1097/01.ccm.0000259466.66310.4f ◽

2007 ◽

Vol 35 (4) ◽

pp. 1153-1160 ◽

Cited By ~ 119

Author(s):

Paul M. Vespa ◽

Kristine O’Phelan ◽

David McArthur ◽

Chad Miller ◽

Matthew Eliseo ◽

...

Keyword(s):

Brain Tissue ◽

Cerebral Perfusion Pressure ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Persistent Elevation ◽

Pyruvate Ratio

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Brain tissue pO2 in relation to cerebral perfusion pressure, TCD findings and TCD-CO2-reactivity after severe head injury

Acta Neurochirurgica ◽

10.1007/bf01420305 ◽

1996 ◽

Vol 138 (4) ◽

pp. 425-434 ◽

Cited By ~ 64

Author(s):

J. Dings ◽

J. Meixensberger ◽

J. Amschler ◽

B. Hamelbeck ◽

K. Roosen

Keyword(s):

Head Injury ◽

Brain Tissue ◽

Cerebral Perfusion Pressure ◽

Cerebral Perfusion ◽

Severe Head Injury ◽

Perfusion Pressure ◽

Co2 Reactivity ◽

Tissue Po2

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Resuscitation of Hypotensive Head-Injured Patients: Is Hypertonic Saline the Answer?

The American Surgeon ◽

10.1177/000313480807400316 ◽

2008 ◽

Vol 74 (3) ◽

pp. 253-259

Author(s):

Jose L. Pascual ◽

Eileen Maloney-Wilensky ◽

Patrick M. Reilly ◽

Corinna Sicoutris ◽

Michael K. Keutmann ◽

...

Keyword(s):

Brain Tissue ◽

Hypertonic Saline ◽

Trauma Center ◽

Tissue Oxygenation ◽

Perfusion Pressure ◽

Inclusion Criteria ◽

Brain Tissue Oxygenation ◽

Head Injured ◽

Level I ◽

Injured Patients

Hypertonic saline (HTS) may decrease intracranial pressure (ICP) in severe traumatic brain injury (STBI) and effectively resuscitates hypotensive patients. No data exist on institutional standardization of HTS for hypotensive patients with STBI. It remains unclear how HTS affects brain tissue oxygenation (PbtO2) in STBI. We hypothesized HTS could be safely standardized in patients with STBI and would lower ICP while improving cerebral perfusion pressure (CPP) and PbtO2. Under institutional guidelines in a Level I trauma center, 12 hypotensive STBI intensive care unit subjects received HTS. Inclusion criteria included mean arterial pressure (MAP) ≤ 90 mmHg, Glasgow Coma Scale (GCS) ≤ 8, ICP ≥ 20 mmHg, and serum [Na+] < 155 mEq/L. All patients underwent ICP monitoring. Hemodynamics, CPP, ICP, and PbtO2 data were collected before and hourly for 6 hours after HTS infusion. Guideline criteria compliance was greater than 95 per cent. No major complications occurred. Mean ICP levels dropped by 45 per cent (P < 0.01) and this drop persisted for 6 hours. CPP levels increased by 20 per cent (P < 0.05). PbtO2 remained persistently elevated for all time points after HTS infusion. Institutional use of HTS in STBI can be safely implemented in a center caring for neurotrauma patients. HTS infusion in hypotensive STBI reduces ICP and raises CPP. Brain tissue oxygenation tends to improve after HTS infusion.

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