Multimodal Evaluation of Cerebral Oxygen Metabolism Disturbances in Patients with Severe Head Injury: Special Reference to Cerebrovascular CO2 Reactivity
In the management of severe head injury patients, hyperventilation (HV) routinely has been used for reduction of intracranial pressure (ICP) or improvement of cerebral acidosis that might otherwise increase the risk of ischemic brain damage [1, 2]. Cerebrovascular CO2 reactivity induced by HV, which has a direct relationship with reduction of cerebral blood flow (CBF) and ICP , also has been suggested to have a close relationship with the prognosis of patients with severe head injuries [4, 5]. This study was aimed at evaluating disturbances in cerebral oxygen metabolism and cerebral hemodynamics, and related factors, on the basis of CO2 reactivity induced by HV in comatose patients with severe head injuries. To this end, we have introduced and analyzed a computerized multimodal system for continuously monitoring jugular bulb venous oxygen saturation (SjO2), arterial oxygen saturation measured by pulse oximeter (SpO2), transcranial Doppier (TCD), end-tidal CO2 partial pressure (PetCO2), ICP, cerebral perfusion pressure (CPP), and Fourier-transformed quantitative electroencephalogram (qEEG) .
KeywordsCerebral Blood Flow Cerebral Perfusion Pressure Glasgow Outcome Scale Severe Head Injury Ischemic Group
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- 1.Cruz J, Miner ME (1986) Modulating cerebral oxygen delivery and extraction in acute traumatic coma. In: Miner ME, Wagner KA (eds) Neurotrauma. Treatment, rehabilitation, and related issues. Butterworths, Boston, pp 55–72Google Scholar
- 3.Marmarou A, Bandoh K, Yoshihara M, Tsuji O (1993) Measurement of vascular reactivity in head-injured patients. Acta Neurochir 59(Suppl): 18–21Google Scholar
- 6.Shiogai T, Sato E, Fujii Y, Takeuchi K, Saito I (1993) Continuous monitoring of transcranial Doppler, jugular venous oxygen saturation, and quantitative EEG in severe head injury. In: Nakamura N, Hashimoto T, Yasue M (eds) Recent advances in neurotraumatology. Springer, Berlin Heidelberg New York Tokyo, pp 297–300CrossRefGoogle Scholar
- 19.Robertson C (1993) Desaturation episodes after severe head injury: influence on outcome. Acta Neurochir 59(Suppl): 98–101Google Scholar