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- Covaciu, Lucian, et al.
(författare)
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Intranasal selective brain cooling in pigs
- 2008
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 78:1, s. 83-88
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Special clinical situations where general hypothermia cannot be recommended but can be a useful treatment demand a new approach, selective brain cooling. The purpose of this study was to selectively cool the brain with cold saline circulating in balloon catheters introduced into the nasal cavity in pigs. MATERIAL AND METHODS: Twelve anaesthetised pigs were subjected to selective cerebral cooling for a period of 6 h. Cerebral temperature was lowered by means of bilaterally introduced nasal balloon catheters perfused with saline cooled by a heat exchanger to 8-10 degrees C. Brain temperature was measured in both cerebral hemispheres. Body temperature was measured in rectum, oesophagus and the right atrium. The pigs were normoventilated and haemodynamic variables were measured continuously. Acid-base and electrolyte status was measured hourly. RESULTS: Cerebral hypothermia was induced rapidly and within the first 20 min of cooling cerebral temperature was lowered from 38.1+/-0.6 degrees C by a mean of 2.8+/-0.6 to 35.3+/-0.6 degrees C. Cooling was maintained for 6 h and the final brain temperature was 34.7+/-0.9 degrees C. Concomitantly, the body temperature, as reflected by oesophageal temperature was decreased from 38.3+/-0.5 to 36.6+/-0.9 degrees C. No circulatory or metabolic disturbances were noted. CONCLUSIONS: Inducing selective brain hypothermia with cold saline via nasal balloon catheters can effectively be accomplished in pigs, with no major disturbances in systemic circulation or physiological variables. The temperature gradients between brain and body can be maintained for at least 6 h.
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| 2. |
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| 3. |
- Neumann, JO, et al.
(författare)
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The use of hyperventilation theraphy after traumatic brain injury in Europe : an analysis of the BrainIT database
- 2008
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 34:9, s. 1676-1682
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess the use of hyperventilation and the adherence to Brain Trauma Foundation-Guidelines (BTF-G) after traumatic brain injury (TBI). Setting Twenty-two European centers are participating in the BrainIT initiative. Design Retrospective analysis of monitoring data. Patients and participants One hundred and fifty-one patients with a known time of trauma and at least one recorded arterial blood–gas (ABG) analysis. Measurements and results A total number of 7,703 ABGs, representing 2,269 ventilation episodes(VE) were included in the analysis. Related minute-by-minute ICP data were taken from a 30 min time window around each ABG collection. Data are given as mean with standard deviation. (1) Patients without elevated intracranial pressure (ICP) (\20 mmHg) manifested a statistically significant higher PaCO2(36 ± 5.7 mmHg) in comparison to patients with elevated ICP(C20 mmHg; PaCO2:34 ± 5.4 mmHg, P\0.001). (2) Intensified forced hyperventilation(PaCO2 B 25 mmHg) in the absence of elevated ICP was found in only 49VE (2%). (3) Early prophylactic hyperventilation (\24 h after TBI;PaCO2 B 35 mmHg,ICP\20 mmHg) was used in 1,224VE (54%). (4) During forced hyperventilation(PaCO2 B 30 mmHg), simultaneous monitoring of brain tissue pO2 or SjvO2 was used in only 204 VE (9%). Conclusion While overall adherence to current BTF-Gseems to be the rule, its recommendations on early prophylactic hyperventilation as well as the use of additional cerebral oxygenation monitoring during forced hyperventilation are not followed in this sample of European TBI centers. Descriptor Neurotrauma
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