Skip to main content
SpringerLink
Log in

CO2 Reactivity and Autoregulation in Severe Head Injury: Bedside Assessment by Relative Changes in Arteriojugular Differences of Oxygen

  • Conference paper
Neurochemical Monitoring in the Intensive Care Unit

Abstract

It has been demonstrated both clinically and in experimental models that autoregulation and CO2 reactivity can be impaired independently of each other in many brain insults, the so-called dissociated vasoparalysis [1]. The theoretical combination of preserved CO2 reactivity and impaired or absent autoregulation can have many clinical implications in the overall daily management of brain-injured patients. To optimize their treatment, a bedside assessment of autoregulation and CO2 reactivity is desirable. In spite of some unresolved and controversial methodological problems, monitoring hemodynamic parameters through a reverse catheter with its tip in the jugular bulb is an easy way of monitoring brain metabolism and cerebral blood flow (CBF) coupling and in some cases of estimating CBF [2-4]. When the cerebral metabolic rate of oxygen (CMRO2) is constant, changes in arteriojugular differences of oxygen (AVDO2) reflect changes in CBF [5]. In this situation, relative changes in AVDO2 can be viewed as inverse changes in CBF and used as an evaluation method of CO2 reactivity and autoregulation. Our aims in this chapter are to use relative changes in AVDO2 after manipulations of mean arterial blood pressure and arterial pCO2 to assess CO2 reactivity and autoregulation in severe head injury patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Paulson OB, Olesen J, Christensen MS (1972) Restoration of autoregulation of cerebral blood flow by hypocapnia (abstr). Neurology 22: 286–293

    PubMed  CAS  Google Scholar 

  2. Cruz J (1992) Jugular venous oxygen saturation monitoring (letter). J Neurosurg 77: 162–163

    PubMed  CAS  Google Scholar 

  3. Cruz J, Gennarelli TA, Alves WM (1992) Continuous monitoring of cerebral oxygenation in acute brain injury: multivariate assessment of severe intracranial “plateau” wave. Case report. J Trauma 32: 401–403

    Article  PubMed  CAS  Google Scholar 

  4. Schmidt JF, Waldemar G, Vorstrup S, Andersen AR, Gjerris F, Paulson OB (1990) Computerized analysis of cerebral blood flow autoregulation in humans: validation of a method for pharmacologic studies. J Cardiovasc Pharmacol 15: 983–988

    Article  PubMed  CAS  Google Scholar 

  5. Robertson CS, Grossman RG, Goodman JC, Narayan RK (1987) The predictive value of cerebral anaerobic metabolism with cerebral infarction after head injury. J Neurosurg 67: 361–368

    Article  PubMed  CAS  Google Scholar 

  6. Goetting MG, Preston G (1990) Jugular bulb catheterization: experience with 123 patients. Crit Care Med 18: 1220–1223

    Article  PubMed  CAS  Google Scholar 

  7. Olsen KS, Videbaek C, Agerlin N, Kroll M, Bogerasmussen T, Paulson OB, Gjerris F (1993) The effect of tirilazad mesylate (u74006 f) on cerebral oxygen consumption, and reactivity of cerebral blood flow to carbon dioxide in healthy volunteers. Anesthesiology 79: 666–671

    Article  PubMed  CAS  Google Scholar 

  8. Davis SM, Ackerman RH, Correia JA, Alpert NM, Chang J, Buonanno F, Kelley RE, Rosner B, Taveras JM (1983) Cerebral blood flow and cerebrovascular CO2 reactivity in stroke-age normal controls. Neurology 33: 391–399

    PubMed  CAS  Google Scholar 

  9. Kety SS, Schmidt CF (1948) The effects of active and passive hyperventilation on cerebral blood flow, cerebral oxygen consumption, cardiac output, and blood pressure of normal young men. J Clin Invest 25: 107–119

    Article  Google Scholar 

  10. Kety SS, Schmidt CF (1948) Effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J Clin Invest 27: 484–492

    Article  CAS  Google Scholar 

  11. McHenry LC Jr, Slocum HC, Bivens HE, Mayes HA, Hayes CJ (1965) Hyperventilation in awake and anesthetized man. Effects on cerebral blood flow and cerebral metabolism. Arch Neurol 12: 270–277

    Article  PubMed  Google Scholar 

  12. Enevoldsen EM, Jensen FT (1978) Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury. J Neurosurg 689: 698–703

    Google Scholar 

  13. Madsen FF (1990) Changes in regional cerebral blood flow after hyperventilation in the pig with an induced focal cerebral contusion. Acta Neurochir (Wien) 106: 164–169

    Article  CAS  Google Scholar 

  14. Muizelaar JP (1989) Induced arterial hypertension in the treatment of high ICP. In: Hoff JT (ed) Intracranial pressure VII. Springer-Verlag, Berlin Heidelberg, pp 508–510

    Chapter  Google Scholar 

  15. Bouma GJ, Muizelaar JP (1990) Relationship between cardiac output and cerebral blood flow in patients with intact and with impaired autoregulation. J Neurosurg 73: 368–374

    Article  PubMed  CAS  Google Scholar 

  16. Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61: 241–253

    Article  PubMed  CAS  Google Scholar 

  17. Bloor BM (1975) Cerebral hemodynamics: the effect of hypoxia on autoregulation and CO2 reactivity. In: Langfitt TW (ed) Cerebral circulation and metabolism. Springer-Verlag, Berlin Heidelberg, pp 55–58

    Chapter  Google Scholar 

  18. Shapiro W, Wasserman AJ, Patterson JL Jr (1965) Human cerebrovascular response time to elevation of arterial carbon dioxide tension. Arch Neurol 13: 130–138

    Article  PubMed  CAS  Google Scholar 

  19. Robertson CS, Narayan RK, Gokaslan ZL, Pahwa R, Grossman RG, Caram P, Allen E (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patiens. J Neurosurg 70: 222–230

    Article  PubMed  CAS  Google Scholar 

  20. Vonhelden A, Schneider GH, Unterberg A, Lanksch WR (1993) Monitoring of jugular venous oxygen saturation in comatose patients with subarachnoid haemorrhage and intracerebral haematomas. Acta Neurochir (Suppl) 59: 102–106

    CAS  Google Scholar 

  21. Edvinsson L, MacKenzie ET, McCulloch J (1993) Disturbed cerebral autoregulation. In: Edvinsson L (ed) Cerebral blood flow and metabolism. Raven, New York, pp 599–609

    Google Scholar 

  22. Muizelaar JP, Becker DP, Lutz HA (1985) Present application and future promise of cerebral blood flow monitoring in head injury. In: Dacey RG (ed) Trauma of the central nervous system. Raven, New York, pp 91–102

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Vall d’Hebron University Hospital, Osona 6, 2-4, Barcelona, 08023, Spain

    Juan Sahuquillo

  2. Department of Neurotraumatology Intensive Care Unit, Vall d’Hebron University Hospital, Osona 6, 2-4, Barcelona, 08023, Spain

    Marcelino Báguena & Laura Campos

  3. Anesthesiology Department, Vall d’Hebron University Hospital, Osona 6, 2-4, Barcelona, 08023, Spain

    Montserrat Olivé

Authors
  1. Juan Sahuquillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcelino Báguena
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Montserrat Olivé
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan

    Takashi Tsubokawa M.D., D.Sc. (Professor and Chairman) (Professor and Chairman)

  2. Division of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA

    Anthony Marmarou Ph.D. (Professor) (Professor)

  3. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA

    Claudia Robertson M.D. (Professor) (Professor)

  4. Department of Neurosurgery, Southern General Hospital, University of Glasgow, Glasgow, Scotland, UK

    Graham Teasdale M.D. (Professor and Chairman) (Professor and Chairman)

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer-Verlag Tokyo

About this paper

Cite this paper

Sahuquillo, J., Báguena, M., Campos, L., Olivé, M. (1995). CO2 Reactivity and Autoregulation in Severe Head Injury: Bedside Assessment by Relative Changes in Arteriojugular Differences of Oxygen. In: Tsubokawa, T., Marmarou, A., Robertson, C., Teasdale, G. (eds) Neurochemical Monitoring in the Intensive Care Unit. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68522-7_23

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-68522-7_23

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-68524-1

  • Online ISBN: 978-4-431-68522-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation