期刊
CRITICAL CARE MEDICINE
卷 36, 期 1, 页码 273-281出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.CCM.0000292014.60835.15
关键词
brain injuries; brain ischemia; oxidative phosphorylation; positron-emission tomography; microdialysis; hyperoxia
资金
- MRC [G0600986, G9439390, G0601025, G0001237] Funding Source: UKRI
- Medical Research Council [G0601025, G0001237, G0600986, G9439390] Funding Source: Medline
Objective: To determine the effect of normobaric hyperoxia on cerebral metabolism in patients with severe traumatic brain injury. Design: Prospective clinical investigation. Setting: Neurosciences critical care unit of a university hospital. Patients: Eleven patients with severe traumatic brain injury. Interventions. Cerebral microdialysis, brain tissue oximetry (Pb0(2)), and oxygen-15 positron emission tomography ((15)0-PET) were undertaken at normoxia and repeated at hyperoxia (F10(2) increase of between 0.35 and 0.50). Measurements and Main Results. Established models were used to image cerebral blood flow, blood volume, oxygen metabolism, and oxygen extraction fraction. Physiology was characterized in a focal region of interest (surrounding the microdialysis catheter) and correlated with microdialysis and oximetry. Physiology was also characterized in a global region of interest (including the whole brain), and a physiologic region of interest (defined using a critical cerebral metabolic rate of oxygen threshold). Hyperoxia increased mean +/- SD Pb0(2) from 28 +/- 21 mm Hg to 57 +/- 47 mm Hg (p = .015). Microdialysate lactate and pyruvate were unchanged, but the lactate/pyruvate ratio showed a statistically significant reduction across the study population (34.1 +/- 9.5 vs. 32.5 +/- 9.0, p = .018). However, the magnitude of reduction was small, and its clinical significance doubtful. The focal region of interest and global (15)0-PET variables were unchanged. Atrisk tissue defined by the physiologic region of interest, however, showed a universal increase in cerebral metabolic rate of oxygen from a median (interquartile range) of 23 (22-25) mu mol(.)100 mL(-1)-min(-1) to 30 (28-36) mu mol(.)100 mL(-1.)min(-1) (p < .01). Conclusions: In severe traumatic brain injury, hyperoxia increases Pb0(2) with a variable effect on lactate and lactate/pyruvate ratio. Microdialysis does not, however, predict the universal increases in cerebral metabolic rate of oxygen in at-risk tissue, which imply preferential metabolic benefit with hyperoxia.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据