Authors: Nils Ståhl Urban Ungerstedt CarlHenrik Nordström
Publish Date: 2014/04/20
Volume: 27, Issue: 7, Pages: 1215-1223
Abstract
Objective To study cerebral biochemical markers with intracerebral microdialysis and bedside analysis in patients with severe head injuries treated with a controlled reduction of cerebral perfusion pressure CPP Design Prospective observational study Setting Neurological intensive care unit in a university hospital Patients A consecutive series of 48 patients with severe head injuries and intracranial pressure ICP above 20 mmHg after conventional treatment Interventions Reduction of CPP was attained with iv infusion of β1antagonist metoprolol and an α2agonist clonidine One microdialysis catheter was inserted via a burr hole frontally to that used for the intraventricular catheter better position In 27 patients one or more catheters were inserted into cerebral cortex surrounding an evacuated focal contusion or underlying an evacuated haematoma worse position Perfusion rate was 03 µl/min and samples were taken every 30 or 60 min The levels of glucose pyruvate lactate glycerol and glutamate were analysed and displayed bedside Results After initiation of treatment mean CPP decreased from 73 to 62 mmHg During the first 96 h CPP was less than 60 mmHg and less than 50 mmHg during 30 and 8 of the time respectively The treatment was associated with a gradual normalisation of all biochemical markers in the better as well as the worse catheter position Conclusion The study shows that pharmacological decrease in CPP according to the Lund concept is associated with a normalisation of cerebral metabolism The study also indicates that intracerebral microdialysis can be used for evaluation of new treatment strategies
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