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Intracranial Pressure and Brain Monitoring XII pp 123–127Cite as

Cerebral blood flow augmentation in patients with severe subarachnoid haemorrhage

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Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 95))

Summary

Following aneurysmal subarachnoid haemorrhage (SAH), cerebral blood flow (CBF) may be reduced, resulting in poor outcome due to cerebral ischaemia and subsequent stroke. Hypertonic saline (HS) is known to be effective in reducing intracranial pressure (ICP) [16]. We have previously shown a 20–50% increase in CBF in ischaemic regions after intravenous infusion of HS [17]. This study aims to determine the effect of HS on CBF augmentation, substrate delivery and metabolism.

Continuous monitoring of arterial blood pressure (ABP), ICP, cerebral perfusion pressure (CPP), brain tissue oxygen (PbO2), middle cerebral artery flow velocity (FV), and microdialysis was performed in 14 poor grade SAH patients. Patients were given an infusion of 23.5% HS, and quantified xenon computerised tomography scanning (XeCT) was carried out before and after the infusion in 9 patients.

The results showed a significant increase in ABP, CPP, FV and PbO2, and a significant decrease in ICP (p < 0.05). Nine patients showed a decrease in lactate-pyruvate ratio at 60 minutes following HS infusion.

These results show that HS safely and effectively augments CBF in patients with poor grade SAH and significantly improves cerebral oxygenation. An improvement in cerebral metabolic status in terms of lactate-pyruvate ratio is also associated with HS infusion.

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References

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Author information

Authors and Affiliations

  1. University Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge, UK

    P. G. Al-Rawi, M. Y. Tseng, P. J. A. Hutchinson & P. J. Kirkpatrick

  2. University Department of Anaesthesia, Addenbrooke’s Hospital, Cambridge, UK

    D. Zygun & B. F. Matta

  3. Department of Critical Care Medicine, University of Calgary, Calgary, Canada

    D. Zygun

Authors
  1. P. G. Al-Rawi
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  2. D. Zygun
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  3. M. Y. Tseng
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  4. P. J. A. Hutchinson
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  5. B. F. Matta
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  6. P. J. Kirkpatrick
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Corresponding author

Correspondence to P. G. Al-Rawi .

Editor information

Editors and Affiliations

  1. Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China

    Wai S. Poon , Matthew T. V. Chan , Keith Y. C. Goh , Joseph M. K. Lam  & Stephanie C. P. Ng , , ,  & 

  2. Medical College of Virginia Commonwealth University, Virginia, USA

    Anthony Marmarou

  3. Academisch Ziekenhuis Dijkzigt, Erasmus University Rotterdam, Rotterdam, The Netherlands

    Cees J. J. Avezaat

  4. Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    John D. Pickard , Marek Czosnyka  & Peter J. A. Hutchinson ,  & 

  5. School of Medicine, Nihon University, Tokyo, Japan

    Yoichi Katayama

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© 2005 Springer-Verlag

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Al-Rawi, P.G., Zygun, D., Tseng, M.Y., Hutchinson, P.J.A., Matta, B.F., Kirkpatrick, P.J. (2005). Cerebral blood flow augmentation in patients with severe subarachnoid haemorrhage. In: Poon, W.S., et al. Intracranial Pressure and Brain Monitoring XII. Acta Neurochirurgica Supplementum, vol 95. Springer, Vienna. https://doi.org/10.1007/3-211-32318-X_27

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  • DOI: https://doi.org/10.1007/3-211-32318-X_27

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-24336-7

  • Online ISBN: 978-3-211-32318-2

  • eBook Packages: MedicineMedicine (R0)

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