Advertisement

Critical Care

, 13:P83 | Cite as

Alteration of cardiopulmonary function after severe head injury

  • E Isotani
  • Y Otomo
  • K Ohno
Poster presentation
  • 783 Downloads

Keywords

Brain Natriuretic Peptide Glasgow Coma Score Severe Head Injury Catecholamine Release Transpulmonary Thermodilution 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Introduction

It is very hard to achieve optimal water balance in severe head injury (SHI) patients (Glasgow coma score ≤ 8). Cardiopulmonary complications are common after SHI: neurogenic pulmonary edema, cardiac failure, and so on [1, 2, 3, 4]. In this study we present the alteration of cardiopulmonary function on pulse contour analysis calibrated by transpulmonary thermodilution (PiCCO-plus) monitoring after SHI.

Methods

Plasma catecholamines, natriuretic polypeptides, thrombomodulin and D-dimer of nine patients were measured immediately after SHI. The cardiopulmonary functions of nine consecutive patients were monitored by PiCCO-plus daily during a week after SHI.

Results

Noradrenalin, dopamine and brain natriuretic peptide concentrations were significantly high during the entire study period. Significantly higher elevations of plasma thrombomodulin and D-dimer concentrations were also observed after SHI. The intrathoracic blood volume was maintained in spite of systemic hypovolemia, and this fluid redistribution caused hydrostatic fluid retention in lung tissues on PiCCO-plus monitoring after SHI. See Figures 1 and 2.
Figure 1

Volume management of SHI patients on PiCCO-plus monitoring. CVP, central venous pressure; SVV, stroke volume variation; PPV, pulse pressure variation.

Figure 2

Lung water content of SHI patients on PiCCO-plus. ELWI, extravascular lung water index; PVPI, pulmonary vascular permeability index; EVLW, extravascular lung water; PBV, pulmonary vascular permeability index.

Conclusion

Persistent catecholamine release and the different sensitivity of blood vessels to catecholamine cause the blood volume redistribution: systemic hypovolemia and hydrostatic pulmonary edema. The excess cardiac preload due to catecholamine release leads to brain natriuretic peptide release resulting in natriuresis.

References

  1. 1.
    Isotani E, et al.: Stroke. 1994, 25: 2198-2203.CrossRefGoogle Scholar
  2. 2.
    Isotani E, et al.: J Cardiovasc Pharmacol. 1996, 28: 639-644. 10.1097/00005344-199611000-00005CrossRefGoogle Scholar
  3. 3.
    Kubota Y, et al.: Vascul Pharmacol. 2007, 47: 90-98. 10.1016/j.vph.2007.04.004CrossRefGoogle Scholar
  4. 4.
    Mizuno Y, et al.: Vascul Pharmacol. 2008, 48: 21-31. 10.1016/j.vph.2007.11.002CrossRefGoogle Scholar

Copyright information

© Isotani et al; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.

Authors and Affiliations

  • E Isotani
    • 1
  • Y Otomo
    • 1
  • K Ohno
    • 1
  1. 1.Tokyo Medical,Dental University,TokyoJapan

Personalised recommendations