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Two approaches to the pressure‐volume relationship after traumatic brain injury using respiratory stimuli (1068.17)
Author(s) -
Haubrich Christina
Publication year - 2014
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.28.1_supplement.1068.17
Subject(s) - hypocapnia , intracranial pressure , cerebral blood flow , respiratory system , traumatic brain injury , anesthesia , medicine , cardiology , blood pressure , parenchyma , vasomotor , hypercapnia , pathology , psychiatry
How to determine the individual pressure‐volume relationship after traumatic brain injury? We have tested two different approaches based on respiratory stimuli.Analysis of 51 TBI patients of which 29 were tested with 30min of moderate hypocapnia (4.4±3.0kPa) and 22 patients were monitored. The analysis was based on intracranial pressure (ICP), Doppler flow velocity (FV) in the middle cerebral arteries, and arterial blood pressure (ABP). Parameters included transfer function Gain for respiratory blood pressure waves (R waves; 9‐20 cpm), vasomotor response (VMR) to moderate short‐term hypocapnia, as well as indices of the pressure ‐ volume reserve (RAP).The four day monitoring of spontaneous ICP changes has shown that rising ICP dampened the transfer of respiratory waves to cerebral vasculature. Moderate short‐term hypocapnia on the other hand, has decreased FV and ICP. Both testing conditions have shown that the largest impact of ICP increase on R wave gains (dGain /dICP right: 0.14±0.06; left: 0.18±0.08) as well as the the largest impact of the hypocapnic VMR on the ICP levels (left:1.8±0.6, right:2.2±0.9 cm/s/kPa/mmHg) were associated with an exhausted p/v reserve (RAP>0.8). The p/v compliance can be assessed by the interaction between intracranial compartments ‐ as between brain parenchyma and cerebral vasculature.