Evaluation of Cerebrovascular CO<inf>2</inf>-Reactivity and Autoregulation in Patients with Post-Traumatic Diffuse Brain Swelling (Diffuse Injury III)

Juan Sahuquillo, F. Munar, M. Baguena, M. A. Poca, S. Pedraza, A. Rodríguez-Baeza

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31 Citations (Scopus)

Abstract

The present study was undertaken to elucidate the status of autoregulation and CO2-reactivity soon after injury in patients with a post-traumatic diffuse bilateral brain swelling. A prospective study was carried out in 31 consecutively admitted patients with a severe head injury and a Diffuse Brain Injury type III, following the definition stated by the Traumatic Coma Data Bank classification. To evaluate CO2-reactivity, AVDO2 was measured before and after ventilator manipulations. Assuming a constant CMRO2 during the test, changes in 1/AVDO2 reflect changes in CBF. Patients with changes in estimated CBF below or equal to 1% were included in the impaired/abolished CO2-reactivity group. To test autoregulation, hypertension was induced using phenylephrine. Arterial and jugular blood samples were taken to calculate AVDO2 before and after a steady state of MABP was obtained. Cerebrovascular response to CO2 was globally preserved in all but two cases (6.5%). In contrast, autoregulation was globally preserved in 10 (32.3%) and impaired/ abolished in 21 cases (67.7%). Our data do not support the premise that increasing cerebral perfusion pressure by inducing arterial hypertension is beneficial in those patients with a diffuse brain swelling in whom autoregulation is impaired or abolished. Clinical implications for treatment are discussed.
Original languageEnglish
Pages (from-to)233-236
JournalActa Neurochirurgica, Supplement
Volume1998
Issue numberSUPPL. 71
DOIs
Publication statusPublished - 1 Jan 1998

Keywords

  • Autoregulation
  • Brain swelling
  • CO -reactivity 2

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