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Cerebral perfusion pressure

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https://www.readbyqxmd.com/read/28511149/analysis-of-extracellular-brain-chemistry-during-percutaneous-dilational-tracheostomy-a-retrospective-study-of-19-patients
#1
Jan Küchler, Jann Wojak, Abdulkareem Abusamha, Claudia Ditz, Volker Martin Tronnier, Jan Gliemroth
OBJECTIVE: The purpose of this study was to analyze changes in brain tissue chemistry around percutaneous dilational tracheostomy (PDT) in patients with acute brain injury (ABI) in a retrospective single-center analysis. PATIENTS AND METHODS: We included 19 patients who had continuous monitoring of brain tissue chemistry and intracranial pressure (ICP) during a 20h period before and after PDT. Different microdialysis parameters (lactate, pyruvate, lactate pyruvate ratio (LPR), glycerol and glutamate) and values of ICP, cerebral perfusion pressure (CPP) and brain tissue oxygenation (PBrO2) were recorded per hour...
May 10, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28499865/implication-of-altered-autonomic-control-for-orthostatic-tolerance-in-sci
#2
REVIEW
Jill Maria Wecht, William A Bauman
Neural output from the sympathetic and parasympathetic branches of the autonomic nervous system (ANS) are integrated to appropriately control cardiovascular responses during routine activities of daily living including orthostatic positioning. Sympathetic control of the upper extremity vasculature and the heart arises from the thoracic cord between T1 and T5, whereas splanchnic bed and lower extremity vasculature receive sympathetic neural input from the lower cord between segments T5 and L2. Although the vasculature is not directly innervated by the parasympathetic nervous system, the SA node is innervated by post-ganglionic vagal nerve fibers via cranial nerve X...
May 3, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/28497934/cerebral-autoregulation-monitoring-in-acute-traumatic-brain-injury-what-s-the-evidence
#3
Leanne A Calviello, Joseph Donnelly, Frederick A Zeiler, Eric P Thelin, Peter Smielewski, Marek Czosnyka
Cerebral autoregulation is conceptualized as a vascular self-regulatory mechanism within the brain. Controlled by elusive relationships between various biophysical processes, it functions to protect the brain against potential damages caused by sudden changes in cerebral perfusion pressures and flow. Following events such as traumatic brain injuries (TBI), autoregulation may be compromised, potentially leading to an unfavorable outcome. In spite of its complexity, autoregulation has been able to be quantified non-invasively within the neuro-critical care setting with the aid of transcranial Doppler...
May 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28492488/redistribution-of-cerebral-blood-flow-during-severe-hypovolemia-and-reperfusion-in-a-sheep-model-critical-role-of-%C3%AE-1-adrenergic-signaling
#4
René Schiffner, Sabine Juliane Bischoff, Thomas Lehmann, Florian Rakers, Sven Rupprecht, Juliane Reiche, Georg Matziolis, Harald Schubert, Matthias Schwab, Otmar Huber, Martin Schmidt
BACKGROUND: Maintenance of brain circulation during shock is sufficient to prevent subcortical injury but the cerebral cortex is not spared. This suggests area-specific regulation of cerebral blood flow (CBF) during hemorrhage. METHODS: Cortical and subcortical CBF were continuously measured during blood loss (≤50%) and subsequent reperfusion using laser Doppler flowmetry. Blood gases, mean arterial blood pressure (MABP), heart rate and renal blood flow were also monitored...
May 11, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28486883/monitoring-of-optimal-cerebral-perfusion-pressure-in-traumatic-brain-injured-patients-using-a-multi-window-weighting-algorithm
#5
Xiuyun Liu, Natasha M Maurits, Marcel J H Aries, Marek Czosnyka, Ari Ercole, Joseph Donnelly, Danilo Cardim, Dong-Joo Kim, Celeste Dias, Manuel Cabeleira, Peter Smieleweski
Methods to identify an autoregulation guided 'optimal' cerebral perfusion pressure (CPPopt) for traumatic brain injury patients (TBI) have been reported through several studies. An important drawback of existing methodology is that CPPopt can be calculated only in approximately 50-60% of the monitoring time. In this study, we hypothesized that the CPPopt yield and the continuity can be improved significantly through application of a multi-window and weighting calculation algorithm, without adversely affecting preservation of its prognostic value...
May 9, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28480040/fty720-elevates-smooth-muscle-contraction-of-aorta-and-blood-pressure-in-rats-via-erk-activation
#6
Zhen Zhao, Jinxin Wang, Zhijun Huo, Zhiyong Wang, Qibing Mei
Sphingosine 1-phosphate (S1P) is an important signaling sphingolipid involved in the pathogenesis of various cardio cerebral vascular diseases such as ischemic stroke. In particular, the S1P mimetic FTY720 is protective for brain against ischemic conditions. However, whether and how FTY720 can modulate vascular tone and blood pressure remains to be determined. We showed that FTY720 (1 mg/kg) enhanced the contractile response of rat thoracic aortic rings induced by high potassium and phenylephrine, respectively...
June 2017: Pharmacology Research & Perspectives
https://www.readbyqxmd.com/read/28469595/apolipoprotein-e-%C3%AE%C2%B54-a-possible-risk-factor-of-intracranial-pressure-and-white-matter-perfusion-in-good-grade-aneurysmal-subarachnoid-hemorrhage-patients-at-early-stage
#7
Jian-Hua Peng, Xing-Hu Qin, Jin-Wei Pang, Yue Wu, Jin-Hu Dong, Chang-Ren Huang, Wei-Feng Wan, Xiao-Bo Yang, Xiao-Chuan Sun, Li-Gang Chen, Yong Jiang
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating and complicated disease with significant morbidity and mortality. Previous studies have shown that genetic susceptibility may play an important role in the outcome of a given individual with aSAH. This study evaluates the potential association in effects of the APOE allele on the early brain injury (EBI) in light of elevated intracranial pressure (ICP) and cerebral perfusion disorders in a consecutive series of non-comatose Chinese patients with aSAH...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28468670/the-effect-of-dexmedetomidine-on-cerebral-perfusion-and-oxygenation-in-healthy-piglets-with-normal-and-lowered-blood-pressure-anaesthetized-with-propofol-remifentanil-total-intravenous-anaesthesia
#8
Mai Louise Grandsgaard Mikkelsen, Rikard Ambrus, Rune Rasmussen, James Edward Miles, Helle Harding Poulsen, Finn Borgbjerg Moltke, Thomas Eriksen
BACKGROUND: During anaesthesia and surgery, in particular neurosurgery, preservation of cerebral perfusion and oxygenation (CPO) is essential for normal postoperative brain function. The isolated effects on CPO of either individual anaesthetic drugs or entire anaesthetic protocols are of importance in both clinical and research settings. Total intravenous anaesthesia (TIVA) with propofol and remifentanil is widely used in human neuroanaesthesia. In addition, dexmedetomidine is receiving increasing attention as an anaesthetic adjuvant in neurosurgical, intensive care, and paediatric patients...
May 3, 2017: Acta Veterinaria Scandinavica
https://www.readbyqxmd.com/read/28446625/use-of-noncontrast-computed-tomography-and-computed-tomographic-perfusion-in-predicting-intracerebral-hemorrhage-after-intravenous-alteplase-therapy
#9
Connor Batchelor, Pooneh Pordeli, Christopher D d'Esterre, Mohamed Najm, Fahad S Al-Ajlan, Mari E Boesen, Connor McDougall, Lisa Hur, Enrico Fainardi, Jai Jai Shiva Shankar, Marta Rubiera, Alexander V Khaw, Michael D Hill, Andrew M Demchuk, Tolulope T Sajobi, Mayank Goyal, Ting-Yim Lee, Richard I Aviv, Bijoy K Menon
BACKGROUND AND PURPOSE: Intracerebral hemorrhage is a feared complication of intravenous alteplase therapy in patients with acute ischemic stroke. We explore the use of multimodal computed tomography in predicting this complication. METHODS: All patients were administered intravenous alteplase with/without intra-arterial therapy. An age- and sex-matched case-control design with classic and conditional logistic regression techniques was chosen for analyses. Outcome was parenchymal hemorrhage on 24- to 48-hour imaging...
April 26, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28420470/-explore-objective-clinical-variables-for-detecting-delirium-in-icu-patients-a-prospective-case-control-study
#10
Xiaojiang Liu, Jie Lyu, Youzhong An
OBJECTIVE: The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients. METHODS: According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU)...
April 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28416148/alterations-in-autonomic-cerebrovascular-control-after-spinal-cord-injury
#11
Dong-Il Kim, Can Ozan Tan
Among chronic cardiovascular and metabolic sequelae of spinal cord injury (SCI) is an up-to four-fold increase in the risk of ischemic and hemorrhagic stroke, suggesting that individuals with SCI cannot maintain stable cerebral perfusion. In able-bodied individuals, the cerebral vasculature is able to regulate cerebral perfusion in response to swings in arterial pressure (cerebral autoregulation), blood gases (cerebral vasoreactivity), and neural metabolic demand (neurovascular coupling). This ability depends, at least partly, on intact autonomic function, but high thoracic and cervical spinal cord injuries result in disruption of sympathetic and parasympathetic cerebrovascular control...
April 4, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/28397372/k-channel-impairment-determines-sex-and-age-differences-in-epinephrine-mediated-outcomes-after-brain-injury
#12
William M Armstead, John Riley, Monica S Vavilala
Traumatic brain injury (TBI) is the leading cause of injury-related death in children, with boys and children under 4 years having particularly poor outcomes. Activation of ATP- and calcium-sensitive (KATP and KCa ) channels produces cerebrovasodilation and contributes to autoregulation, both of which are impaired after TBI, contributing to poor outcomes. Upregulation of the c-Jun-terminal kinase (JNK) isoform of mitogen-activated protein kinase produces K channel function impairment after CNS injury. Vasoactive agents can be used to normalize cerebral perfusion pressure...
April 11, 2017: Journal of Neuroscience Research
https://www.readbyqxmd.com/read/28395665/retinal-arterial-blood-flow-and-retinal-changes-in-patients-with-sepsis-preliminary-study-using-fluorescein-angiography
#13
Kristo Erikson, Janne Henrik Liisanantti, Nina Hautala, Juha Koskenkari, Remi Kamakura, Karl Heinz Herzig, Hannu Syrjälä, Tero Ilmari Ala-Kokko
BACKGROUND: Although tissue perfusion is often decreased in patients with sepsis, the relationship between macrohemodynamics and microcirculatory blood flow is poorly understood. We hypothesized that alterations in retinal blood flow visualized by angiography may be related to macrohemodynamics, inflammatory mediators, and retinal microcirculatory changes. METHODS: Retinal fluorescein angiography was performed twice during the first 5 days in the intensive care unit to observe retinal abnormalities in patients with sepsis...
April 10, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28389734/-intensive-care-treatment-of-traumatic-brain-injury-in-multiple-trauma-patients-decision-making-for-complex-pathophysiology
#14
H Trimmel, G Herzer, H Schöchl, W G Voelckel
Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. The mainstays of TBI intensive care may be, at least temporarily, contradictory to the trauma care concept for multiple trauma patients...
April 7, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28389601/anterior-cerebral-blood-velocity-and-end-tidal-co2-responses-to-exercise-differ-in-children-and-adults
#15
Lindsay A Ellis, Philip N Ainslie, Victoria A Armstrong, Laura Emily Morris, Ryan Gerard Simair, Nathan R Sletten, Christine M Tallon, Ali Mary McManus
Little is known about the response of the cerebrovasculature to acute exercise in children and how these responses might differ with adults. Therefore, we compared changes in middle cerebral artery blood velocity (MCAVmean), partial pressure of end-tidal carbon dioxide (PETCO2), blood pressure and ventilation (VE) in response to incremental exercise between children and adults. Thirteen children [aged 9±1 (SD) y] and 13 sex-matched adults [aged 25±4 y] completed a maximal exercise test during which MCAVmean, PETCO2 and VE were measured continuously...
April 7, 2017: American Journal of Physiology. Heart and Circulatory Physiology
https://www.readbyqxmd.com/read/28385097/cerebral-perfusion-pressure-insults-and-associations-with-outcome-in-adult-traumatic-brain-injury
#16
Fabian Giza, Geert Meyfroidt, Ian Piper, Giuseppe Citerio, Iain Chambers, Per Enblad, Pelle Nilsson, Bart Feyen, Philippe Jorens, Andrew Maas, Martin Ulrich Schuhmann, Rob Donald, Laura Moss, Greet Van den Berghe, Bart Depreitere
The definition of cerebral perfusion pressure (CPP) secondary insults in severe traumatic brain injury remains unclear. The purpose of the present study is to visualize the association of intensity and duration of episodes below or above cerebral perfusion pressure thresholds and outcome. The analysis was based on prospectively collected minute-by-minute intracranial pressure (ICP) and blood pressure data and outcome from 259 adult patients. The relationship of episodes of CPP below or above a certain threshold for certain duration with the 6-month Glasgow Outcome Score was visualized, separately for episodes of active or deficient autoregulation (AR)...
April 7, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28383324/cerebral-autoregulation-oriented-therapy-at-the-bedside-a-comprehensive-review
#17
Lucia Rivera-Lara, Andres Zorrilla-Vaca, Romergryko G Geocadin, Ryan J Healy, Wendy Ziai, Marek A Mirski
This comprehensive review summarizes the evidence regarding use of cerebral autoregulation-directed therapy at the bedside and provides an evaluation of its impact on optimizing cerebral perfusion and associated functional outcomes. Multiple studies in adults and several in children have shown the feasibility of individualizing mean arterial blood pressure and cerebral perfusion pressure goals by using cerebral autoregulation monitoring to calculate optimal levels. Nine of these studies examined the association between cerebral perfusion pressure or mean arterial blood pressure being above or below their optimal levels and functional outcomes...
April 6, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28375909/syncope
#18
William P Cheshire
PURPOSE OF REVIEW: Syncope is a prevalent syndrome with diverse causes, which have in common a sudden transient failure of the autonomic nervous system to maintain blood pressure against the force of gravity at a level sufficient for cerebral perfusion. Neurally mediated syncope is an episodic phenomenon in which autonomic nervous system function is normal the rest of the time. Although relatively benign, syncope increases the risk for injury from falling and can substantially impair patients' quality of life...
April 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28373858/enhanced-cholinergic-activity-improves-cerebral-blood-flow-during-orthostatic-stress
#19
Jorge M Serrador, Roy Freeman
Cerebral blood flow (CBF) and consequently orthostatic tolerance when upright depends on dilation of the cerebral vasculature in the face of reduced perfusion pressure associated with the hydrostatic gradient. However, it is still unclear if cholinergic activation plays a role in this dilation. To determine if enhancing central cholinergic activity with the centrally acting acetylcholinesterase inhibitor, physostigmine would increase CBF when upright compared to the peripherally acting acetylcholinesterase inhibitor, neostigmine, or saline...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28372905/apoe-%C3%AE%C2%B54-positive-patients-suffering-severe-traumatic-head-injury-are-more-prone-to-undergo-decompressive-hemicraniectomy
#20
Zandra Olivecrona, Lars-Owe D Koskinen
OBJECT: In this paper we tested the hypothesis if patients with severe traumatic brain injury and presence of the apolipoprotein E (APOE) ε4 allele are more prone to undergo the surgical procedure decompressive hemicraniectomy (DC) in order to bring the intracranial pressure (ICP) under control. METHODS: In this prospective consecutive study patients with sTBI were enrolled (n=48). Inclusion criteria were arrival to our level one trauma university hospital within 24h after trauma, patient age between 15 and 70years, Glasgow Coma Scale (GCS) score ≤8 at the time of intubation and sedation, an initial cerebral perfusion pressure >10mmHg...
March 31, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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