PMID- 22037222
OWN - NLM
STAT- MEDLINE
DCOM- 20120123
LR  - 20240214
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Print)
IS  - 0007-0912 (Linking)
VI  - 108
IP  - 1
DP  - 2012 Jan
TI  - What comes first? The dynamics of cerebral oxygenation and blood flow in response 
      to changes in arterial pressure and intracranial pressure after head injury.
PG  - 89-99
LID - 10.1093/bja/aer324 [doi]
AB  - BACKGROUND: Brain tissue partial oxygen pressure (Pbt(O(2))) and near-infrared 
      spectroscopy (NIRS) are novel methods to evaluate cerebral oxygenation. We 
      studied the response patterns of Pbt(O(2)), NIRS, and cerebral blood flow 
      velocity (CBFV) to changes in arterial pressure (AP) and intracranial pressure 
      (ICP). METHODS: Digital recordings of multimodal brain monitoring from 42 
      head-injured patients were retrospectively analysed. Response latencies and 
      patterns of Pbt(O(2)), NIRS-derived parameters [tissue oxygenation index (TOI) 
      and total haemoglobin index (THI)], and CBFV reactions to fluctuations of AP and 
      ICP were studied. RESULTS: One hundred and twenty-one events were identified. In 
      reaction to alterations of AP, ICP reacted first [4.3 s; inter-quartile range 
      (IQR) -4.9 to 22.0 s, followed by NIRS-derived parameters and CBFV (10.9 s; IQR: 
      -5.9 to 39.6 s, 12.1 s; IQR: -3.0 to 49.1 s, 14.7 s; IQR: -8.8 to 52.3 s for THI, 
      CBFV, and TOI, respectively), with Pbt(O(2)) reacting last (39.6 s; IQR: 16.4 to 
      66.0 s). The differences in reaction time between NIRS parameters and Pbt(O(2)) 
      were significant (P<0.001). Similarly when reactions to ICP changes were 
      analysed, NIRS parameters preceded Pbt(O(2)) (7.1 s; IQR: -8.8 to 195.0 s, 18.1 
      s; IQR: -20.6 to 80.7 s, 22.9 s; IQR: 11.0 to 53.0 s for THI, TOI, and Pbt(O(2)), 
      respectively). Two main patterns of responses to AP changes were identified. With 
      preserved cerebrovascular reactivity, TOI and Pbt(O(2)) followed the direction of 
      AP. With impaired cerebrovascular reactivity, TOI and Pbt(O(2)) decreased while 
      AP and ICP increased. In 77% of events, the direction of TOI changes was 
      concordant with Pbt(O(2)). CONCLUSIONS: NIRS and transcranial Doppler signals 
      reacted first to AP and ICP changes. The reaction of Pbt(O(2)) is delayed. The 
      results imply that the analysed modalities monitor different stages of cerebral 
      oxygenation.
FAU - Budohoski, K P
AU  - Budohoski KP
AD  - Division of Neurosurgery, Department of Clinical Neurosciences, University of 
      Cambridge, Addenbrooke' s Hospital, Hills Road, Cambridge CB2 0QQ, UK. 
      kpb26@cam.ac.uk
FAU - Zweifel, C
AU  - Zweifel C
FAU - Kasprowicz, M
AU  - Kasprowicz M
FAU - Sorrentino, E
AU  - Sorrentino E
FAU - Diedler, J
AU  - Diedler J
FAU - Brady, K M
AU  - Brady KM
FAU - Smielewski, P
AU  - Smielewski P
FAU - Menon, D K
AU  - Menon DK
FAU - Pickard, J D
AU  - Pickard JD
FAU - Kirkpatrick, P J
AU  - Kirkpatrick PJ
FAU - Czosnyka, M
AU  - Czosnyka M
LA  - eng
GR  - G0001237/MRC_/Medical Research Council/United Kingdom
GR  - G9439390/MRC_/Medical Research Council/United Kingdom
GR  - G1000183/MRC_/Medical Research Council/United Kingdom
GR  - G0600986/MRC_/Medical Research Council/United Kingdom
GR  - G0001354/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111027
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
MH  - Adult
MH  - Algorithms
MH  - Blood Pressure/*physiology
MH  - Brain Chemistry/physiology
MH  - Cerebrovascular Circulation/*physiology
MH  - Craniocerebral Trauma/*physiopathology
MH  - Data Interpretation, Statistical
MH  - Female
MH  - Glasgow Coma Scale
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Intracranial Pressure/*physiology
MH  - Male
MH  - Monitoring, Physiologic
MH  - Oxygen Consumption/*physiology
MH  - Prospective Studies
MH  - Spectroscopy, Near-Infrared
MH  - Ultrasonography, Doppler, Transcranial
PMC - PMC3236021
EDAT- 2011/11/01 06:00
MHDA- 2012/01/24 06:00
PMCR- 2013/01/01
CRDT- 2011/11/01 06:00
PHST- 2011/11/01 06:00 [entrez]
PHST- 2011/11/01 06:00 [pubmed]
PHST- 2012/01/24 06:00 [medline]
PHST- 2013/01/01 00:00 [pmc-release]
AID - S0007-0912(17)32519-9 [pii]
AID - aer324 [pii]
AID - 10.1093/bja/aer324 [doi]
PST - ppublish
SO  - Br J Anaesth. 2012 Jan;108(1):89-99. doi: 10.1093/bja/aer324. Epub 2011 Oct 27.