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Xenon-CT and transcranial Doppler in poor-grade or complicated aneurysmatic subarachnoid hemorrhage patients undergoing aggressive management of intracranial hypertension

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Abstract

Objective

To evaluate whether elevated flow velocimetry values are associated with critically reduced cerebral blood flow values in deeply sedated patients with acute aneurysmatic subarachnoid hemorrhage and in whom the detection of clinical vasospasm is not feasible.

Design

Retrospective analysis of prospectively collected data.

Setting

Neurosurgical and trauma patients in an intensive care unit in a regional hospital.

Patients and participants

Twenty-nine patients in the acute phase following subarachnoid hemorrhage who were sedated and ventilated for elevated intracranial pressure, transcranial Doppler vasospasm, or respiratory failure and were studied with at least a coupled xenon-CT/transcranial Doppler study.

Measurements and results

Combined measurement and comparison of cerebral blood flow by means of xenon-CT and of mean velocity by means of transcranial Doppler in middle cerebral artery territories. The case mix studied was consistent with patients' predominantly poor grade and with a complicated course. The results suggest that in sedated patients flow velocity and measured cortical mixed cerebral blood flow are not correlated, and, more specifically, that flow velocities values above 120 or 160 cm/s and Lindegaard index above 3 are not associated with an ischemic regional cerebral blood flow. Conversely, as many as 55% of the xenon-CT studies were associated with hyperemia.

Conclusions

In patients with elevated intracranial pressure, mean middle cerebral artery flow velocity or Lindegaard Index does not help to detect critical cerebral blood flow nor elevated cerebral blood flow.

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Acknowledgements

We are indebted to Dr. Francesco Cocciolo (U.O. Anestesia e Rianimazione, Cesena) for collecting data on demography and severity, Claudia Turrini and Federica Sarpieri (U.O. Anestesia e Rianimazione, Cesena) for collecting data on physiological and treatment variables, Wilma Benedettini (U.O. Anestesia e Rianimazione, Cesena) for collecting data on final outcome, Maurizio Ravaldini (U.O. Anestesia e Rianimazione, Cesena) for data base building (data on demography, severity, physiological and treatment variables; data on outcome; data from Xe-CT analysis), Dr. Rosario Pascarella (U.O. Neuroradiologia, Cesena) for assistance in Xe-CT studies, Dr. Enrico Fainardi (U.O. Neuroradiologia, Ferrara) for Xe-CT studies and Xe-CT data collection, and Dr. Roberto Battaglia (U.O. Neurochirurgia, Cesena) for TCD studies and data on treatment variables. We are grateful to Dr. Frank Rasulo (2° Servizio di Anestesia e Rianimazione, Spedali Riuniti, Università di Brescia) for his critical revision, Chi-Sang Poon (Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, USA) for his useful suggestions concerning the application of different methods to pooling multiple subject data for linear analysis, and Chung Tin (Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, USA) for his intervention on the explorative standardization and averaging of data concerning multiple measurements.

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  1. Ospedale M. Bufalini, Unità Operativa Anestesia e Rianimazione, Viale Ghirotti 286, 47023, Cesena, Italy

    Arturo Chieregato, Giuseppe Sabia, Alessandra Tanfani, Christian Compagnone, Fernanda Tagliaferri & Luigi Targa

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  1. Arturo Chieregato
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Correspondence to Arturo Chieregato.

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Chieregato, A., Sabia, G., Tanfani, A. et al. Xenon-CT and transcranial Doppler in poor-grade or complicated aneurysmatic subarachnoid hemorrhage patients undergoing aggressive management of intracranial hypertension . Intensive Care Med 32, 1143–1150 (2006). https://doi.org/10.1007/s00134-006-0226-2

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