caa a22 4500 477107583 CHVBK 20180405111558.0 cr unu---uuuuu 170330e19960301xx s 000 0 eng 10.1007/BF01411736 doi (NATIONALLICENCE)springer-10.1007/BF01411736 CO2 and indomethacin vasoreactivity in patients with head injury [Elektronische Daten] [B. Dahl, B. Bergholt, G. Cold, J. Astrup, B. Mosdal, K. Jensen, J. Kjærsgaard] Summary: The purpose of this study was to compare the effect of hyper-ventilation and indomethacin on cerebral circulation, metabolism and pressures in patients with acute severe head injury in order to see if indomethacin may act supplementary to hyperventilation. Fourteen severely head injured patients entered the study. Intracranial pressure (ICP), mean arterial blood pressure (MABP) and cerebral perfusion pressure (CPP) were monitored continuously. Within the first four days after the trauma the CO2 and indomethacin vasoreactivities were studied by measurements of cerebral blood flow (CBF) (Cerebrograph 10a, intravenous133Xe technique) and arterio-venous difference of oxygen (AVdO2). Ischaemia was evaluated from changes in CBF, saturation of oxygen in the jugular bulb (SvjO2), lactate and lactate/oxygen index (LOI). Data are presented as medians and ranges, results are significant unless otherwise indicated. Before intervention ICP was well controlled (14.8 (9-24) mmHg) and basic CBF level was 39.1 (21.6-75.0) ml/100 g/min). The arterio-venous oxygen differences were generally decreased (AVdO2 = 4.3 (1.8-8.1) ml/100 ml) indicating moderate luxury perfusion. Levels of CMRO2 were decreased (1.54 (0.7-3.2) ml/100 g/min) as well. Duringhyperventilation (ΔAPaCO2 = 0.88 (0.62-1.55) kPa) CBF decreased with 11.8 (−33.4−29.7) %/kPa and ICP decreased with 3.8 (0-10) mmHg. AVdO2 increased 34.0 (4.0-139.2) %/kPa, MABP was unchanged, CMRO2 and CPP increased (ΔCPP = 3.9 (−10−20) mmHg). AVD (lactate) and LOI were unchanged. No correlations between CBF responses to hypocapnia and outcomes were observed. An i.v. bolus dose ofindomethacin (30 mg) decreased CBF 14.7 (−16.7−57.4) % and ICP decreased 4.3 (−1−17) mmHg. AVdO2 increased 27.8 (−40.0−66.7)%, MABP (ΔMABP = 4.9 (−2−21) mmHg) and CPP (ΔCPP = 8.7 (3-29) mmHg) increased while CMRO2 was unchanged. No changes in AVd (lactate) and LOI indicating cerebral ischaemia were found. Compared to hyperventilation (changes per 1 kPa, at PaCO2 level = 4.05 kPa) the changes in MABP, CPP and CBF were significantly greater after indomethacin, while the changes in AVdO2, ICP, SvjO2, and LOI were of the same order of magnitude. Nocorrelation between relative reactivities to indomethacin and CO2, evaluated from changes in CBF and AVdO2, or between the decrease in ICP after the two procedures were found. Thus, some patients reacted to indomethacin but not to hyperventilation, and vice versa. These results suggest that indomethacin and hyperventilation might act independently, or in a complementary fashion in the treatment of patients with severe head injury. Springer-Verlag, 1996 Head injury nationallicence indomethacin reactivity nationallicence hyperventilation nationallicence intracranial pressure nationallicence cerebral blood flow nationallicence cerebral ischaemia nationallicence Dahl B. Department of Neuroanaesthesia, Århus University Hospital, Århus, Denmark aut Bergholt B. Department of Neurosurgery, Århus University Hospital, Århus, Denmark aut Cold G. Department of Neuroanaesthesia, Århus University Hospital, Århus, Denmark aut Astrup J. Department of Neurosurgery, Århus University Hospital, Århus, Denmark aut Mosdal B. Department of Neurosurgery, Århus University Hospital, Århus, Denmark aut Jensen K. Department of Neuroanaesthesia, Århus University Hospital, Århus, Denmark aut Kjærsgaard J. Department of Neurosurgery, Århus University Hospital, Århus, Denmark aut Acta Neurochirurgica Springer-Verlag 138/3(1996-03-01), 265-273 0001-6268 138:3<265 1996 138 701 https://doi.org/10.1007/BF01411736 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF01411736 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Dahl B. Department of Neuroanaesthesia, Århus University Hospital, Århus, Denmark aut NATIONALLICENCE 700 1- Bergholt B. Department of Neurosurgery, Århus University Hospital, Århus, Denmark aut NATIONALLICENCE 700 1- Cold G. Department of Neuroanaesthesia, Århus University Hospital, Århus, Denmark aut NATIONALLICENCE 700 1- Astrup J. Department of Neurosurgery, Århus University Hospital, Århus, Denmark aut NATIONALLICENCE 700 1- Mosdal B. Department of Neurosurgery, Århus University Hospital, Århus, Denmark aut NATIONALLICENCE 700 1- Jensen K. Department of Neuroanaesthesia, Århus University Hospital, Århus, Denmark aut NATIONALLICENCE 700 1- Kjærsgaard J. Department of Neurosurgery, Århus University Hospital, Århus, Denmark aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer-Verlag 138/3(1996-03-01), 265-273 0001-6268 138:3<265 1996 138 701 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer