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Continuous Monitoring of Cerebrospinal Fluid Acid-Base Balance and Oxygen Metabolism in Patients with Severe Head Injury: Pathophysiology and Treatments for Cerebral Acidosis and Ischemia

  • Conference paper
Neuromonitoring in Brain Injury

Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 75))

Summary

Introduction. Continuous monitoring of cerebral acid-base balance and oxygen metabolism has been introduced in neurointensive care settings. The hypothesis of this study utilizing multimodal neuromonitoring modalities is that hyperventilation and hypothermia improve cerebral acidosis through prevention of cerebral ischemia aggravation in patients with severe head injury.

Patients and Methods. Continuous monitoring of cerebrospinal fluid (CSF) pH, PC02, HC03-, base excess (BE), P02, S02, temperature, lactate and pyruvate (La and Py) measurements were conducted in 8 patients with severe head injury. Temperature-corrected CSF parameters were correlated with those in the jugUlar blood including oxygen saturation (Sj02), regional oxygen saturation (rS02), intracranial pressure (lCP) and cerebral perfusion pressure (CPP), jugular blood temperature (Tjb), and endtidal PC02 (PetC02).Therapeutic significance of hyperventilation and hypothermia was evaluated.

Results. I) CSF acidosis was observed in all cases (minimum pH 6.59-7.17) due to increased CSF PCO2 and/or decreased CSF HC03- and tended to associate with abnormal ICP and/or CPP or ischemic episodes indicated by CSF P02 and S02, rS02, and/or Sj02 during monitoring. 2) It was more obvious in CSF than in jugular blood that increased PCO2, La and Py, and/or decreased HC03- resulted in decreased BE and pH. 3) Decreased CSF P02 and S02 only correlated with severe CSF acidosis. 4) Hyperventilation: Decreased PetC02 did not always closely correlate with CSF PC02 decrease and CSFpH increase. 5) Hypothermia: There were negative correlations ofTjb with CSF pH and S02 in all cases. though correlationcoefficients were not always high.

Conclusions. CSF acidosis caused by increased CSF PC02. La and Py, and/or decreased HC03 - tended to associate with abnormal ICP and CPP, and desaturation indicated by CSF S02, rS02, and/or Sj02. Hypothermia rather than hyperventilation tends to improve cerebral acidosis and ischemia.

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Authors and Affiliations

  1. Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan

    T. Shiogai, I. Nara, K. Saruta, M. Hara & I. Saito

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  1. T. Shiogai
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  2. I. Nara
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  3. K. Saruta
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  4. M. Hara
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Editors and Affiliations

  1. Department of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University Richmond, USA

    R. Bullock , A. Marmarou  & B. Alessandri ,  & 

  2. Neurological Surgery, Sacramento, CA, USA

    J. Watson

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© 1999 Springer-Verlag Wien

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Shiogai, T., Nara, I., Saruta, K., Hara, M., Saito, I. (1999). Continuous Monitoring of Cerebrospinal Fluid Acid-Base Balance and Oxygen Metabolism in Patients with Severe Head Injury: Pathophysiology and Treatments for Cerebral Acidosis and Ischemia. In: Bullock, R., Marmarou, A., Alessandri, B., Watson, J. (eds) Neuromonitoring in Brain Injury. Acta Neurochirurgica Supplements, vol 75. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6415-0_11

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  • DOI: https://doi.org/10.1007/978-3-7091-6415-0_11

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-7319-0

  • Online ISBN: 978-3-7091-6415-0

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