A187 EFFECTS OF PROLONGED HYPOCAPNIA ON CEREBRAL HEMODYNAMIC AND OXYGENATION STATUS IN SEVERE HEAD TRAUMA (SHT)

The extent and timing of posttraumatic cerebral hemodynamic disturbances have significant implications for the monitoring and treatment of patients with head injury. This prospective study of cerebral blood flow (CBF) (measured using 133Xe clearance) and transcranial Doppler (TCD) measurements in 125 patients with severe head trauma has defined three distinct hemodynamic phases during the first 2 weeks after injury. The phases are further characterized by measurements of cerebral arteriovenous oxygen difference (AVDO2) and cerebral metabolic rate of oxygen (CMRO2). Phase I (hypoperfusion phase) occurs on the day of injury (Day 0) and is defined by a low CBF15 calculated from cerebral clearance curves integrated to 15 minutes (mean CBF15 32.3 ± 2 ml/100 g/minute), normal middle cerebral artery (MCA) velocity (mean VMCA 56.7 ± 2.9 cm/second), normal hemispheric index (mean HI 1.67 ± 0.11), and normal AVDO2 (mean AVDO2 5.4 ± 0.5 vol%). The CMRO2 is approximately 50% of normal (mean CMRO2 1.77 ± 0.18 ml/100 g/minute) during this phase and remains depressed during the second and third phases. In Phase II (hyperemia phase, Days 1-3), CBF increases (46.8 ± 3 ml/100 g/minute), AVDO2 falls (3.8 ± 0.1 vol%), VMCA velocity rises (86 ± 3.7 cm/second), and the HI remains less than 3 (2.41 ± 0.1). In Phase III (vasospasm phase, Days 4-15), there is a fall in CBF (35.7 ± 3.8 ml/100 g/minute), a further increase in VMCA (96.7 ± 6.3 cm/second), and a pronounced rise in the HI (2.87 ± 0.22). This is the first study in which CBF, metabolic, and TCD measurements are combined to define the characteristics and time courses of, and to suggest etiological factors for, the distinct cerebral hemodynamic phases that occur after severe craniocerebral trauma. This research is consistent with and builds on the findings of previous investigations and may provide a useful temporal framework for the organization of existing knowledge regarding posttraumatic cerebrovascular and metabolic pathophysiology.

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Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm

Journal of Neurosurgery ◽

10.3171/jns.1997.87.1.0009 ◽

1997 ◽

Vol 87 (1) ◽

pp. 9-19 ◽

Cited By ~ 318

Author(s):

Neil A. Martin ◽

Ravish V. Patwardhan ◽

Michael J. Alexander ◽

Cynthia Zane Africk ◽

Jae Hong Lee ◽

...

Keyword(s):

Head Trauma ◽

Craniocerebral Trauma ◽

Phase Iii ◽

Severe Head Trauma ◽

Content Type ◽

Cerebral Hemodynamic ◽

Normal Mean ◽

Time Courses ◽

Fine Print

✓ The extent and timing of posttraumatic cerebral hemodynamic disturbances have significant implications for the monitoring and treatment of patients with head injury. This prospective study of cerebral blood flow (CBF) (measured using 133Xe clearance) and transcranial Doppler (TCD) measurements in 125 patients with severe head trauma has defined three distinct hemodynamic phases during the first 2 weeks after injury. The phases are further characterized by measurements of cerebral arteriovenous oxygen difference (AVDO2) and cerebral metabolic rate of oxygen (CMRO2). Phase I (hypoperfusion phase) occurs on the day of injury (Day 0) and is defined by a low CBF15 calculated from cerebral clearance curves integrated to 15 minutes (mean CBF15 32.3 ± 2 ml/100 g/minute), normal middle cerebral artery (MCA) velocity (mean VMCA 56.7 ± 2.9 cm/second), normal hemispheric index ([HI], mean HI 1.67 ± 0.11), and normal AVDO2 (mean AVDO2 5.4 ± 0.5 vol%). The CMRO2 is approximately 50% of normal (mean CMRO2 1.77 ± 0.18 ml/100 g/minute) during this phase and remains depressed during the second and third phases. In Phase II (hyperemia phase, Days 1–3), CBF increases (46.8 ± 3 ml/100 g/minute), AVDO2 falls (3.8 ± 0.1 vol%), VMCA rises (86 ± 3.7 cm/second), and the HI remains less than 3 (2.41 ± 0.1). In Phase III (vasospasm phase, Days 4–15), there is a fall in CBF (35.7 ± 3.8 ml/100 g/minute), a further increase in VMCA (96.7 ± 6.3 cm/second), and a pronounced rise in the HI (2.87 ± 0.22). This is the first study in which CBF, metabolic, and TCD measurements are combined to define the characteristics and time courses of, and to suggest etiological factors for, the distinct cerebral hemodynamic phases that occur after severe craniocerebral trauma. This research is consistent with and builds on the findings of previous investigations and may provide a useful temporal framework for the organization of existing knowledge regarding posttraumatic cerebrovascular and metabolic pathophysiology.

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X-linked Adrenoleukodystrophy: Severe Head Trauma Masked Diagnosis—A Case Report

Neuropediatrics ◽

10.1055/s-0034-1390606 ◽

2014 ◽

Vol 45 (S 01) ◽

Author(s):

E. Haber ◽

M. Brunner-Krainz ◽

W. Erwa ◽

U. Gruber-Sedlmeyer ◽

A. Schwerin-Nagel ◽

...

Keyword(s):

Case Report ◽

Head Trauma ◽

Severe Head Trauma

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Study of PbiO2 Variation by Body Temperature and Capnia in Severe Head Trauma Patients Treated With Targeted Temperature Control

Case Medical Research ◽

10.31525/ct1-nct04109430 ◽

2019 ◽

Author(s):

Keyword(s):

Body Temperature ◽

Head Trauma ◽

Temperature Control ◽

Trauma Patients ◽

Severe Head Trauma

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243 Jugular Bulb Metabolic Data within First 12-Hours After Severe Head Trauma

Prehospital and Disaster Medicine ◽

10.1017/s1049023x0004855x ◽

1993 ◽

Vol 8 (S3) ◽

pp. S128-S129

Author(s):

C.S De Deyne ◽

J.M Decruyenaere ◽

J.I Poelaert ◽

F.A Colardyn

Keyword(s):

Head Trauma ◽

Jugular Bulb ◽

Severe Head Trauma ◽

Metabolic Data

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Client-Centered Emergency Care

Nursing, Law & Ethics ◽

10.1017/s0270663600001904 ◽

1981 ◽

Vol 2 (6) ◽

pp. 1-4

Author(s):

Jennifer MacPherson

Keyword(s):

Emergency Room ◽

Head Trauma ◽

Emergency Care ◽

Severe Head Trauma ◽

Best Interest ◽

Motorcycle Accident ◽

Florence Nightingale ◽

Centered Care ◽

Patient Emergency

Since Florence Nightingale, nurses have agreed that care should be individualized for each patient. Emergency care is no different and texts on this subject instruct the nurse to involve the client in his own care and to recognize that being an emergency victim is physically and psychologically difficult for the client. But just what is client-centered emergency care and are clients getting it?A client is brought to the emergency room, unconscious, with severe head trauma resulting from a motorcycle accident. In this instance client-centered care consists of the nurse reacting swiftly and probably unemotionally. It is not in the client's best interest at this time for the nurse to try to ascertain that person's values and life views. Here client-centered care is compatible with the values and views of both the nurse and the institution.

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