Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates

Jonathan P. Coles; Pawan S. Minhas; Tim D. Fryer; Peter Smielewski; Franklin Aigbirihio; Tim Donovan; Stephen P M J Downey; Guy Williams; Dot Chatfield; Julian C. Matthews; Arun K. Gupta; T. Adrian Carpenter; John C. Clark; John D. Pickard; David K. Menon

doi:10.1097/00003246-200209000-00002

Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates

Jonathan P. Coles, Pawan S. Minhas, Tim D. Fryer, Peter Smielewski, Franklin Aigbirihio, Tim Donovan, Stephen P M J Downey, Guy Williams, Dot Chatfield, Julian C. Matthews, Arun K. Gupta, T. Adrian Carpenter, John C. Clark, John D. Pickard, David K. Menon

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: To investigate the effect of hyperventilation on cerebral blood flow in traumatic brain injury. Design: A prospective interventional study. Setting: A specialist neurocritical care unit. Patients: Fourteen healthy volunteers and 33 patients within 7 days of closed head injury. Interventions: All subjects underwent positron emission tomography imaging of cerebral blood flow. In patients, Paco2 was reduced from 36 ± 1 to 29 ± 1 torr (4.8 ± 0.1 to 3.9 ± 0.1 kPa) and measurements repeated. Jugular venous saturation (Sjvo2) and arteriovenous oxygen content differences (AVDO2) were monitored in 25 patients and values related to positron emission tomography variables. Measurements and Main Results: The volumes of critically hypoperfused and hyperperfused brain (HypoBV and HyperBV, in milliliters) were calculated based on thresholds of 10 and 55 mL·100g-1·min-1, respectively. Whereas baseline HypoBV was significantly higher in patients (p <.05), baseline HyperBV was similar to values in healthy volunteers. Hyperventilation resulted in increases in cerebral perfusion pressure (p <.0001) and reductions in intracranial pressure (p <.001), whereas Sjvo2 (>50%) and AVDO2 (

Original language	English
Pages (from-to)	1950-1959
Number of pages	9
Journal	Critical Care Medicine
Volume	30
Issue number	9
DOIs	https://doi.org/10.1097/00003246-200209000-00002
Publication status	Published - 1 Sept 2002

Keywords

Cerebral blood flow
Cerebral oxygenation
Head injury
Hyperventilation
Ischemia
Positron emission tomography

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10.1097/00003246-200209000-00002

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Coles, J. P., Minhas, P. S., Fryer, T. D., Smielewski, P., Aigbirihio, F., Donovan, T., Downey, S. P. M. J., Williams, G., Chatfield, D., Matthews, J. C., Gupta, A. K., Carpenter, T. A., Clark, J. C., Pickard, J. D., & Menon, D. K. (2002). Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates. Critical Care Medicine, 30(9), 1950-1959. https://doi.org/10.1097/00003246-200209000-00002

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title = "Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates",

abstract = "Objective: To investigate the effect of hyperventilation on cerebral blood flow in traumatic brain injury. Design: A prospective interventional study. Setting: A specialist neurocritical care unit. Patients: Fourteen healthy volunteers and 33 patients within 7 days of closed head injury. Interventions: All subjects underwent positron emission tomography imaging of cerebral blood flow. In patients, Paco2 was reduced from 36 ± 1 to 29 ± 1 torr (4.8 ± 0.1 to 3.9 ± 0.1 kPa) and measurements repeated. Jugular venous saturation (Sjvo2) and arteriovenous oxygen content differences (AVDO2) were monitored in 25 patients and values related to positron emission tomography variables. Measurements and Main Results: The volumes of critically hypoperfused and hyperperfused brain (HypoBV and HyperBV, in milliliters) were calculated based on thresholds of 10 and 55 mL·100g-1·min-1, respectively. Whereas baseline HypoBV was significantly higher in patients (p <.05), baseline HyperBV was similar to values in healthy volunteers. Hyperventilation resulted in increases in cerebral perfusion pressure (p <.0001) and reductions in intracranial pressure (p <.001), whereas Sjvo2 (>50%) and AVDO2 (",

keywords = "Cerebral blood flow, Cerebral oxygenation, Head injury, Hyperventilation, Ischemia, Positron emission tomography",

author = "Coles, {Jonathan P.} and Minhas, {Pawan S.} and Fryer, {Tim D.} and Peter Smielewski and Franklin Aigbirihio and Tim Donovan and Downey, {Stephen P M J} and Guy Williams and Dot Chatfield and Matthews, {Julian C.} and Gupta, {Arun K.} and Carpenter, {T. Adrian} and Clark, {John C.} and Pickard, {John D.} and Menon, {David K.}",

year = "2002",

month = sep,

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doi = "10.1097/00003246-200209000-00002",

language = "English",

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journal = "Critical Care Medicine",

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Coles, JP, Minhas, PS, Fryer, TD, Smielewski, P, Aigbirihio, F, Donovan, T, Downey, SPMJ, Williams, G, Chatfield, D, Matthews, JC, Gupta, AK, Carpenter, TA, Clark, JC, Pickard, JD & Menon, DK 2002, 'Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates', Critical Care Medicine, vol. 30, no. 9, pp. 1950-1959. https://doi.org/10.1097/00003246-200209000-00002

TY - JOUR

T1 - Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates

AU - Coles, Jonathan P.

AU - Minhas, Pawan S.

AU - Fryer, Tim D.

AU - Smielewski, Peter

AU - Aigbirihio, Franklin

AU - Donovan, Tim

AU - Downey, Stephen P M J

AU - Williams, Guy

AU - Chatfield, Dot

AU - Matthews, Julian C.

AU - Gupta, Arun K.

AU - Carpenter, T. Adrian

AU - Clark, John C.

AU - Pickard, John D.

AU - Menon, David K.

PY - 2002/9/1

Y1 - 2002/9/1

N2 - Objective: To investigate the effect of hyperventilation on cerebral blood flow in traumatic brain injury. Design: A prospective interventional study. Setting: A specialist neurocritical care unit. Patients: Fourteen healthy volunteers and 33 patients within 7 days of closed head injury. Interventions: All subjects underwent positron emission tomography imaging of cerebral blood flow. In patients, Paco2 was reduced from 36 ± 1 to 29 ± 1 torr (4.8 ± 0.1 to 3.9 ± 0.1 kPa) and measurements repeated. Jugular venous saturation (Sjvo2) and arteriovenous oxygen content differences (AVDO2) were monitored in 25 patients and values related to positron emission tomography variables. Measurements and Main Results: The volumes of critically hypoperfused and hyperperfused brain (HypoBV and HyperBV, in milliliters) were calculated based on thresholds of 10 and 55 mL·100g-1·min-1, respectively. Whereas baseline HypoBV was significantly higher in patients (p <.05), baseline HyperBV was similar to values in healthy volunteers. Hyperventilation resulted in increases in cerebral perfusion pressure (p <.0001) and reductions in intracranial pressure (p <.001), whereas Sjvo2 (>50%) and AVDO2 (

AB - Objective: To investigate the effect of hyperventilation on cerebral blood flow in traumatic brain injury. Design: A prospective interventional study. Setting: A specialist neurocritical care unit. Patients: Fourteen healthy volunteers and 33 patients within 7 days of closed head injury. Interventions: All subjects underwent positron emission tomography imaging of cerebral blood flow. In patients, Paco2 was reduced from 36 ± 1 to 29 ± 1 torr (4.8 ± 0.1 to 3.9 ± 0.1 kPa) and measurements repeated. Jugular venous saturation (Sjvo2) and arteriovenous oxygen content differences (AVDO2) were monitored in 25 patients and values related to positron emission tomography variables. Measurements and Main Results: The volumes of critically hypoperfused and hyperperfused brain (HypoBV and HyperBV, in milliliters) were calculated based on thresholds of 10 and 55 mL·100g-1·min-1, respectively. Whereas baseline HypoBV was significantly higher in patients (p <.05), baseline HyperBV was similar to values in healthy volunteers. Hyperventilation resulted in increases in cerebral perfusion pressure (p <.0001) and reductions in intracranial pressure (p <.001), whereas Sjvo2 (>50%) and AVDO2 (

KW - Cerebral blood flow

KW - Cerebral oxygenation

KW - Head injury

KW - Hyperventilation

KW - Ischemia

KW - Positron emission tomography

U2 - 10.1097/00003246-200209000-00002

DO - 10.1097/00003246-200209000-00002

M3 - Article

SN - 0090-3493

VL - 30

SP - 1950

EP - 1959

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 9

ER -

Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates

Abstract

Keywords

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