Relationship between Global and Cortical Cerebral Blood Flow in Patients with Head Injuries

Relationship between Global and Cortical Cerebral Blood Flow in Patients with Head Injuries AbstractOBJECTIVEThe goal of this study was to analyze the use of thermal diffusion-cerebral blood flow (TD-CBF) monitoring as a continuous monitoring method for patients with head injuries in the intensive care unit.METHODSThe TD-CBF probe was placed on normal-appearing frontal or parietal cortex at the time of surgery to treat traumatic intracranial hematomas in 35 patients, and cortical cerebral blood flow (CBF) was monitored for up to 7 days after surgery. We compared TD-CBF values with global CBF values measured by the standard Kety-Schmidt technique, and we compared changes in TD-CBF with changes in jugular venous oxygen saturation observed during intracranial pressure elevations.RESULTSThe average value for the global CBF measurements was 50.5 ± 0.9 ml/100 g/min and that for the TD-CBF measurements was 60.5 ±1.4 ml/100 g/min; the average difference was 9.3 ±1.2 ml/100 g/min. The overall slope of the regression between the global CBF and TD-CBF measurements (n = 206) was 0.636 (comparison of observed slope with a slope of 0, P < 0.001). The relationship between the TD-CBF and global CBF values during 546 episodes of increased intracranial pressure was examined by comparing the changes in TD-CBF with the changes in jugular venous oxygen saturation. When the change in TD-CBF was at least 10 ml/100 g/min during an intracranial pressure elevation, the TD-CBF change reflected the change in jugular venous oxygen saturation on 85% of the occasions.CONCLUSIONThe TD-CBF method is very convenient because of the continuous and automatic nature of the measurements. Most of the time, a change in TD-CBF indicated a similar change in global CBF. However, the limitations of local measurements of CBF must be kept in mind during therapeutic decision-making. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Relationship between Global and Cortical Cerebral Blood Flow in Patients with Head Injuries

Relationship between Global and Cortical Cerebral Blood Flow in Patients with Head Injuries

Relationship between Global and Cortical Cerebral Blood Shankar P. Gopinath, M.D., Alex Valadka, M .D., Charles F. Contant, Ph.D., Claudia S. Robertson, M.D. Department of Neurosurgery, Baylor College of M edicine, Houston, Texas OBJECTIVE: T h e g o a l o f t h is s t u d y w a s to a n a l y z e the u se o f t h e r m a l d i f f u s i o n - c e r e b r a l b lo o d f l o w ( T D - C B F ) monitoring as a c o n t i n u o u s m o n i t o r i n g m e t h o d for p a t ie n t s w it h h e a d i n j u r i e s in th e i n t e n s i v e c a r e u n it. METHODS: T h e T D - C B F p r o b e w a s p l a c e d o n n o r m a l - a p p e a r i n g f r o n t a l o r p a r ie t a l c o r t e x at th e t im e o f s u r g e r y to treat trau m atic i n t r a c r a n i a l h e m a t o m a s in 3 5 p a tie n ts, a n d c o r t i c a l c e r e b r a l b lo o d f l o w ( C B F ) w a s m o n i t o r e d fo r up to 7 days a f t e r s u r g e r y . W e c o m p a r e d T D - C B F v a lu e s w i t h g lo b a l C B F v a l u e s m e a s u r e d by th e s t a n d a r d Kety-Schmidt t e c h n i q u e , a n d w e c o m p a r e d c h a n g e s in T D - C B F w it h c h a n g e s in j u g u l a r v e n o u s o x y g e n s a t u r a t i o n observed d u rin g i n t r a c r a n i a l p r e s s u r e e l e v a t i o n s . RESULTS: The a v e r a g e v a l u e f o r t h e g lo b a l C B F m e a s u r e m e n t s w a s 5 0 . 5 ± 0 . 9 m l / 1 0 0 g / m in a n d th a t fo r th e T D - C B F measurements w a s 6 0 . 5 ± 1 . 4 m l / 1 0 0 g / m in ; the a v e r a g e d i f f e r e n c e w a s 9 . 3 ± 1 . 2 m l / 1 0 0 g / m in . T h e o v e r a l l slope of the r e g r e s s io n b e t w e e n th e g lo b a l C B F a n d T D - C B F m e a s u r e m e n t s (n = 2 0 6 ) w a s 0 . 6 3 6 ( c o m p a r i s o n o f observed slo p e w i t h a s l o p e o f 0 , P < 0 . 0 0 1 ) . T h e r e l a t i o n s h i p b e t w e e n th e T D - C B F a n d g lo b a l C B F v a l u e s d u r i n...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199906000-00066
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVEThe goal of this study was to analyze the use of thermal diffusion-cerebral blood flow (TD-CBF) monitoring as a continuous monitoring method for patients with head injuries in the intensive care unit.METHODSThe TD-CBF probe was placed on normal-appearing frontal or parietal cortex at the time of surgery to treat traumatic intracranial hematomas in 35 patients, and cortical cerebral blood flow (CBF) was monitored for up to 7 days after surgery. We compared TD-CBF values with global CBF values measured by the standard Kety-Schmidt technique, and we compared changes in TD-CBF with changes in jugular venous oxygen saturation observed during intracranial pressure elevations.RESULTSThe average value for the global CBF measurements was 50.5 ± 0.9 ml/100 g/min and that for the TD-CBF measurements was 60.5 ±1.4 ml/100 g/min; the average difference was 9.3 ±1.2 ml/100 g/min. The overall slope of the regression between the global CBF and TD-CBF measurements (n = 206) was 0.636 (comparison of observed slope with a slope of 0, P < 0.001). The relationship between the TD-CBF and global CBF values during 546 episodes of increased intracranial pressure was examined by comparing the changes in TD-CBF with the changes in jugular venous oxygen saturation. When the change in TD-CBF was at least 10 ml/100 g/min during an intracranial pressure elevation, the TD-CBF change reflected the change in jugular venous oxygen saturation on 85% of the occasions.CONCLUSIONThe TD-CBF method is very convenient because of the continuous and automatic nature of the measurements. Most of the time, a change in TD-CBF indicated a similar change in global CBF. However, the limitations of local measurements of CBF must be kept in mind during therapeutic decision-making.

Journal

NeurosurgeryOxford University Press

Published: Jun 1, 1999

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