Cerebral blood flow and metabolism in children with severe head injuries. Part 2: Cerebrovascular resistance and its determinants
| Autor: | Janet Eyre, P M Sharples, D. S. F. Matthews |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
Male
Time Factors Adolescent Cerebral circulation Oxygen Consumption medicine Homeostasis Humans Glasgow Coma Scale Autoregulation Cerebral perfusion pressure Child business.industry Brain Pathophysiology Psychiatry and Mental health medicine.anatomical_structure Cerebral blood flow Brain Injuries Cerebrovascular Circulation Child Preschool Anesthesia Vascular resistance Female Vascular Resistance Surgery Neurology (clinical) business Research Article Blood vessel |
| Zdroj: | Journal of Neurology, Neurosurgery & Psychiatry. 58:153-159 |
| ISSN: | 0022-3050 |
| DOI: | 10.1136/jnnp.58.2.153 |
| Popis: | It has been proposed that in children with severe head injuries the cerebral circulation does not respond appropriately to normal physiological control mechanisms, making children more susceptible than adults to low cerebrovascular resistance, increased cerebral blood flow (cerebral hyperaemia), and raised intracranial pressure. To investigate this issue, 122 serial measurements of cerebrovascular resistance in 17 children with severe head injuries have been performed and related to cerebral perfusion pressure, arterial CO2 (PaCO2), arterial oxygen content (AO2), and the cerebral metabolic rate of oxygen (CMRO2). Cerebrovascular resistance values (mean (SD) 1.54 (0.61) mm Hg.ml-1.100 g.min) were normal or raised in most cases; 71 values (58%) were within the normal range, 39 (32%) above the upper limit, and only 12 (10%) below the lower limit. There was a significant correlation between cerebral perfusion pressure and cerebrovascular resistance (r = 0.32, p = 0.0003), suggesting preservation of pressure autoregulation. This correlation was absent in four of the five children who died or survived with severe handicap. Analysis by multilevel modelling indicated that, as in normal subjects, CMRO2, CPP, AO2, PaCO2, and cerebrovenous pH were important independent determinants of cerebrovascular resistance. The results indicate that normal cerebrovascular reactivity is often preserved in children with severe head injuries but may be impaired in the most severely injured patients. |
| Databáze: | OpenAIRE |
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