TY - JOUR
T1 - Effect of osmotic agents on regional cerebral blood flow in traumatic brain injury
AU - Scalfani, Michael T.
AU - Dhar, Rajat
AU - Zazulia, Allyson R.
AU - Videen, Tom O.
AU - Diringer, Michael N.
N1 - Funding Information:
The authors thank Angela Shackelford, RN, John Hood, and the cyclotron and NNICU staff for their assistance in conducting this research and caring for these patients. This work was supported by the NIH National Center for Research Resources ( UL1 RR024992 ) and the NIH National Institutes of Neurological Disorders and Stroke ( 5P01NS035966 ).
PY - 2012/10
Y1 - 2012/10
N2 - Purpose: Cerebral blood flow (CBF) is reduced after severe traumatic brain injury (TBI) with considerable regional variation. Osmotic agents are used to reduce elevated intracranial pressure (ICP), improve cerebral perfusion pressure, and presumably improve CBF. Yet, osmotic agents have other physiologic effects that can influence CBF. We sought to determine the regional effect of osmotic agents on CBF when administered to treat intracranial hypertension. Materials and Methods: In 8 patients with acute TBI, we measured regional CBF with positron emission tomography before and 1 hour after administration of equi-osmolar 20% mannitol (1 g/kg) or 23.4% hypertonic saline (0.686 mL/kg) in regions with focal injury and baseline hypoperfusion (CBF <25 mL per 100 g/min). Results: The ICP fell (22.4 ± 5.1 to 15.7 ± 7.2 mm Hg, P = .007), and cerebral perfusion pressure rose (75.7 ± 5.9 to 81.9 ± 10.3 mm Hg, P = .03). Global CBF tended to rise (30.9 ± 3.7 to 33.1 ± 4.2 mL per 100 g/min, P = .07). In regions with focal injury, baseline flow was 25.7 ± 9.1 mL per 100 g/min and was unchanged; in hypoperfused regions (15% of regions), flow rose from 18.6 ± 5.0 to 22.4 ± 6.4 mL per 100 g/min (P < .001). Osmotic therapy reduced the number of hypoperfused brain regions by 40% (P < .001). Conclusion: Osmotic agents, in addition to lowering ICP, improve CBF to hypoperfused brain regions in patients with intracranial hypertension after TBI.
AB - Purpose: Cerebral blood flow (CBF) is reduced after severe traumatic brain injury (TBI) with considerable regional variation. Osmotic agents are used to reduce elevated intracranial pressure (ICP), improve cerebral perfusion pressure, and presumably improve CBF. Yet, osmotic agents have other physiologic effects that can influence CBF. We sought to determine the regional effect of osmotic agents on CBF when administered to treat intracranial hypertension. Materials and Methods: In 8 patients with acute TBI, we measured regional CBF with positron emission tomography before and 1 hour after administration of equi-osmolar 20% mannitol (1 g/kg) or 23.4% hypertonic saline (0.686 mL/kg) in regions with focal injury and baseline hypoperfusion (CBF <25 mL per 100 g/min). Results: The ICP fell (22.4 ± 5.1 to 15.7 ± 7.2 mm Hg, P = .007), and cerebral perfusion pressure rose (75.7 ± 5.9 to 81.9 ± 10.3 mm Hg, P = .03). Global CBF tended to rise (30.9 ± 3.7 to 33.1 ± 4.2 mL per 100 g/min, P = .07). In regions with focal injury, baseline flow was 25.7 ± 9.1 mL per 100 g/min and was unchanged; in hypoperfused regions (15% of regions), flow rose from 18.6 ± 5.0 to 22.4 ± 6.4 mL per 100 g/min (P < .001). Osmotic therapy reduced the number of hypoperfused brain regions by 40% (P < .001). Conclusion: Osmotic agents, in addition to lowering ICP, improve CBF to hypoperfused brain regions in patients with intracranial hypertension after TBI.
KW - Cerebral blood flow
KW - Intracranial hypertension
KW - Osmotic agents
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=84862176168&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2011.10.008
DO - 10.1016/j.jcrc.2011.10.008
M3 - Article
C2 - 22176808
AN - SCOPUS:84862176168
SN - 0883-9441
VL - 27
SP - 526.e7-526.e12
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 5
ER -