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CBF changes and cer...
CBF changes and cerebral energy metabolism during hypervolemia, hemodilution, and hypertension therapy in patients with poor-grade subarachnoid hemorrhage
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- Engquist, Henrik (author)
- Uppsala universitet,Enblad: Neurokirurgi,Anestesiologi och intensivvård
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- Lewén, Anders, 1965- (author)
- Uppsala universitet,Enblad: Neurokirurgi
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- Hillered, Lars, 1952- (author)
- Uppsala universitet,Enblad: Neurokirurgi
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- Ronne-Engström, Elisabeth (author)
- Uppsala universitet,Enblad: Neurokirurgi
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- Nilsson, Pelle (author)
- Uppsala universitet,Enblad: Neurokirurgi
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- Enblad, Per (author)
- Uppsala universitet,Enblad: Neurokirurgi
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- Rostami, Elham, 1979- (author)
- Karolinska Institutet,Uppsala universitet,Enblad: Neurokirurgi
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(creator_code:org_t)
- Journal of Neurosurgery Publishing Group (JNSPG), 2021
- 2021
- English.
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In: Journal of Neurosurgery. - : Journal of Neurosurgery Publishing Group (JNSPG). - 0022-3085 .- 1933-0693. ; 134:2, s. 555-564
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.3...
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Abstract
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- OBJECTIVE: Despite the multifactorial pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH), augmentation of cerebral blood flow (CBF) is still considered essential in the clinical management of DCI. The aim of this prospective observational study was to investigate cerebral metabolic changes in relation to CBF during therapeutic hypervolemia, hemodilution, and hypertension (HHH) therapy in poor-grade SAH patients with DCI.METHODS: CBF was assessed by bedside xenon-enhanced CT at days 0–3, 4–7, and 8–12, and the cerebral metabolic state by cerebral microdialysis (CMD), analyzing glucose, lactate, pyruvate, and glutamate hourly. At clinical suspicion of DCI, HHH therapy was instituted for 5 days. CBF measurements and CMD data at baseline and during HHH therapy were required for study inclusion. Non-DCI patients with measurements in corresponding time windows were included as a reference group.RESULTS: In DCI patients receiving HHH therapy (n = 12), global cortical CBF increased from 30.4 ml/100 g/min (IQR 25.1–33.8 ml/100 g/min) to 38.4 ml/100 g/min (IQR 34.2–46.1 ml/100 g/min; p = 0.006). The energy metabolic CMD parameters stayed statistically unchanged with a lactate/pyruvate (L/P) ratio of 26.9 (IQR 22.9–48.5) at baseline and 31.6 (IQR 22.4–35.7) during HHH. Categorized by energy metabolic patterns during HHH, no patient had severe ischemia, 8 showed derangement corresponding to mitochondrial dysfunction, and 4 were normal. The reference group of non-DCI patients (n = 11) had higher CBF and lower L/P ratios at baseline with no change over time, and the metabolic pattern was normal in all these patients.CONCLUSIONS: Global and regional CBF improved and the cerebral energy metabolic CMD parameters stayed statistically unchanged during HHH therapy in DCI patients. None of the patients developed metabolic signs of severe ischemia, but a disturbed energy metabolic pattern was a common occurrence, possibly explained by mitochondrial dysfunction despite improved microcirculation.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- subarachnoid hemorrhage
- cerebral blood flow
- delayed cerebral ischemia
- xenon CT
- XeCT
- Neurokirurgi
- Neurosurgery
Publication and Content Type
- ref (subject category)
- art (subject category)
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Engquist, Henrik
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Lewén, Anders, 1 ...
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Hillered, Lars, ...
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Ronne-Engström, ...
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Nilsson, Pelle
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Enblad, Per
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Rostami, Elham, ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Neurology
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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Journal of Neuro ...
- By the university
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Uppsala University
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Karolinska Institutet