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Cerebral perfusion pressure

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https://www.readbyqxmd.com/read/29355383/changes-of-cortical-perfusion-in-the-early-phase-of-subarachnoid-bleeding-in-a-rat-model-and-the-role-of-intracranial-hypertension
#1
M Kolar, K Nohejlova, F Duska, J Mares, J Pachl
Brain perfusion is reduced early after subarachnoid hemorrhage (SAH) due to intracranial hypertension and early vasospasm. The contribution of these two mechanisms is unknown. By performing a prophylactic decompressive craniectomy (DC) in a rat model of SAH we aimed to study brain perfusion after the component of intracranial hypertension has been eliminated. We used 2x2 factorial design, where rats received either decompressive craniectomy or sham operation followed by injection of 250 microl of blood or normal saline into prechiasmatic cistern...
December 30, 2017: Physiological Research
https://www.readbyqxmd.com/read/29344708/treatment-of-combined-traumatic-brain-injury-and-hemorrhagic-shock-with-fractionated-blood-products-versus-fresh-whole-blood-in-a-rat-model
#2
Akiva Leibowitz, Evgeni Brotfain, Leonid Koyfman, Moti Klein, Shmuel Hess, Alexander Zlotnik, Matthew Boyko
INTRODUCTION: Treatment of combined traumatic brain injury and hemorrhagic shock, poses a particular challenge due to the possible conflicting consequences. While restoring diminished volume is the treatment goal for hypovolemia, maintaining adequate cerebral perfusion pressure and avoidance of secondary damage remains a treatment goal for the injured brain. Various treatment modalities have been proposed, but the optimal resuscitation fluid and goals have not yet been clearly defined...
January 17, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29339713/neuroprotective-effect-of-selective-antegrade-cerebral-perfusion-during-prolonged-deep-hypothermic-circulatory-arrest-cerebral-metabolism-evidence-in-a-pig-model
#3
Zhixian Tang, Mengya Liang, Guangxian Chen, Jian Rong, Jianping Yao, Zhen Chen, Xiao Yang, Zhongkai Wu
OBJECTIVE: The aim of this study was to elucidate the mechanism of cerebral injury and to evaluate selective antegrade cerebral perfusion (SACP) as a superior neuroprotective strategy for prolonged deep hypothermic circulatory arrest (DHCA). METHODS: Twelve pigs (6-8-week old) were randomly assigned to DHCA alone (n=6) and DHCA with SACP (n=6) at 18°C for 80 min groups. Serum S100 was determined using an immunoassay analyzer. The concentrations of cerebral dialysate glucose, lactate, pyruvate, glycerol, and glutamate were measured using a microdialysis analyzer...
January 2018: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/29337811/individualizing-cerebral-perfusion-pressure-targets
#4
Francis Bernard, Martin Albert, Véronique Brunette
No abstract text is available yet for this article.
February 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29336770/limit-crystalloid-resuscitation-after-traumatic-brain-injury
#5
Ara Ko, Megan Y Harada, Galinos Barmparas, Eric J T Smith, Kurtis Birch, Zachary R Barnard, Dorothy A Yim, Eric J Ley
Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected...
December 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29331091/terminal-spreading-depolarization-and-electric-silence-in-death-of-human-cortex
#6
Jens P Dreier, Sebastian Major, Brandon Foreman, Maren K L Winkler, Eun-Jeung Kang, Denny Milakara, Coline L Lemale, Vince DiNapoli, Jason M Hinzman, Johannes Woitzik, Norberto Andaluz, Andrew Carlson, Jed A Hartings
OBJECTIVE: Restoring the circulation is the primary goal in emergency treatment of cerebral ischemia. However, better understanding of how the brain responds to energy depletion could inform the time available for resuscitation until irreversible damage and advance development of interventions that prolong this span. Experimentally, injury to central neurons begins only with anoxic depolarization. This potentially reversible, spreading wave typically starts 2-5 min after the onset of severe ischemia, marking the onset of a toxic intraneuronal change that eventually results in irreversible injury...
January 13, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29311754/correlation-between-cerebral-hemodynamic-and-perfusion-pressure-changes-in-non-human-primates
#7
A Ruesch, M A Smith, G Wollstein, I A Sigal, S Nelson, J M Kainerstorfer
The mechanism that maintains a stable blood flow in the brain despite changes in cerebral perfusion pressure (CPP), and therefore guaranties a constant supply of oxygen and nutrients to the neurons, is known as cerebral autoregulation (CA). In a certain range of CPP, blood flow is mediated by a vasomotor adjustment in vascular resistance through dilation of blood vessels. CA is known to be impaired in diseases like traumatic brain injury, Parkinson's disease, stroke, hydrocephalus and others. If CA is impaired, blood flow and pressure changes are coupled and the oxygen supply might be unstable...
February 2017: Proceedings of SPIE
https://www.readbyqxmd.com/read/29298527/a-narrative-review-of-the-clinical-application-of-pressure-reactiviy-indices-in-the-neurocritical-care-unit
#8
Stephen Copplestone, Jessie Welbourne
Pressure reactivity indices are used in clinical research as a surrogate marker of the ability of the cerebrovasculature to maintain cerebral autoregulation. The use of pressure reactivity indices in patients with neurological injury represents a potential to move away from population-based physiological targets used in guidelines to individualized physiological targets. The aim of this review is to describe the underlying principles and development of pressure reactivity indices, alongside a critique of how they have been used in clinical research, including their limitations...
January 4, 2018: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/29288841/management-of-severe-traumatic-brain-injury-first-24-hours
#9
Thomas Geeraerts, Lionel Velly, Lamine Abdennour, Karim Asehnoune, Gérard Audibert, Pierre Bouzat, Nicolas Bruder, Romain Carrillon, Vincent Cottenceau, François Cotton, Sonia Courtil-Teyssedre, Claire Dahyot-Fizelier, Frédéric Dailler, Jean-Stéphane David, Nicolas Engrand, Dominique Fletcher, Gilles Francony, Laurent Gergelé, Carole Ichai, Etienne Javouhey, Pierre-Etienne Leblanc, Thomas Lieutaud, Philippe Meyer, Sébastien Mirek, Gilles Orliaguet, François Proust, Hervé Quintard, Catherine Ract, Mohamed Srairi, Karim Tazarourte, Bernard Vigué, Jean-François Payen
The latest French Guidelines for the management in the first 24hours of patients with severe traumatic brain injury (TBI) were published in 1998. Due to recent changes (intracerebral monitoring, cerebral perfusion pressure management, treatment of raised intracranial pressure), an update was required. Our objective has been to specify the significant developments since 1998. These guidelines were conducted by a group of experts for the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation (SFAR)) in partnership with the Association de Neuro-Anesthésie-Réanimation de Langue Française (ANARLF), the Société Française de Neurochirurgie (SFN), the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP) and the Association des Anesthésistes-Réanimateurs Pédiatriques d'Expression Française (ADARPEF)...
December 27, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29287672/-impact-of-hypotension-and-global-hypoperfusion-in-postoperative-delirium-a-pilot-study-in-older-adults-undergoing-open-colon-surgery
#10
Eduardo Tobar, Mario A Abedrapo, Jaime A Godoy, Jose L Llanos, Mauricio J Díaz, Rodrigo Azolas, Gunther R Bocic, Jaime A Escobar, Rodrigo A Cornejo, Carlos M Romero
BACKGROUND: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. METHODS: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery...
December 26, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29286398/evaluation-of-vascular-control-mechanisms-utilizing-video-microscopy-of-isolated-resistance-arteries-of-rats
#11
Kathleen M Lukaszewicz, Matthew J Durand, Jessica R C Priestley, James R Schmidt, L Adrienne Allen, Aron M Geurts, Julian H Lombard
This protocol describes the use of in vitro television microscopy to evaluate vascular function in isolated cerebral resistance arteries (and other vessels), and describes techniques for evaluating tissue perfusion using Laser Doppler Flowmetry (LDF) and microvessel density utilizing fluorescently labeled Griffonia simplicifolia (GS1) lectin. Current methods for studying isolated resistance arteries at transmural pressures encountered in vivo and in the absence of parenchymal cell influences provide a critical link between in vivo studies and information gained from molecular reductionist approaches that provide limited insight into integrative responses at the whole animal level...
December 5, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29285704/direct-perfusion-of-the-carotid-artery-in-patients-with-brain-malperfusion-secondary-to-acute-aortic-dissection
#12
Yutaka Okita, Yuki Ikeno, Koki Yokawa, Yojiro Koda, Soichiro Henmi, Yasuko Gotake, Hidekazu Nakai, Takashi Matsueda, Takeshi Inoue, Hiroshi Tanaka
OBJECTIVE: Presenting our experience of direct perfusion of the carotid artery in patients with brain malperfusion secondary to acute aortic dissection. PATIENTS: Among 381 patients who underwent aortic repair for acute type A aortic dissection from October 1999 to August 2017, brain malperfusion was recognized in 50 patients. Nine patients had direct perfusion of the right carotid artery in patients with brain malperfusion secondary to acute aortic dissection. Age at surgery was 65...
December 28, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29283434/elevation-of-the-head-during-intensive-care-management-in-people-with-severe-traumatic-brain-injury
#13
REVIEW
Jose D Alarcon, Andres M Rubiano, David O Okonkwo, Jairo Alarcón, Maria José Martinez-Zapata, Gerard Urrútia, Xavier Bonfill Cosp
BACKGROUND: Traumatic brain injury (TBI) is a major public health problem and a fundamental cause of morbidity and mortality worldwide. The burden of TBI disproportionately affects low- and middle-income countries. Intracranial hypertension is the most frequent cause of death and disability in brain-injured people. Special interventions in the intensive care unit are required to minimise factors contributing to secondary brain injury after trauma. Therapeutic positioning of the head (different degrees of head-of-bed elevation (HBE)) has been proposed as a low cost and simple way of preventing secondary brain injury in these people...
December 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29262436/multimodality-monitoring-toward-improved-outcomes
#14
Richard Gandee, Chad Miller
Multimodality monitoring provides insights into the critically ill brain-injured patient through the assessment of biochemical, physiological, and electrical data that provides insight into a patient's condition and what strategies may be available to limit further damage and improve the odds for recovery. Modalities utilized include evaluation of intracranial pressure along with cerebral perfusion pressure to determine adequate blood flow; continuous electroencephalography to protect the patient from seizures and to identify early functional manifestations of ischemia and toxicity; transcranial Doppler evaluation for bedside review of circulatory adequacy; tissue oxygen monitoring to establish that brain tissue is receiving adequate oxygen from blood flow; and microdialysis to evaluate the metabolic function of the tissue in areas of concern...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29259732/edaravone-a-synthetic-free-radical-scavenger-enhances-alteplase-mediated-thrombolysis
#15
Kiyoshi Kikuchi, Kentaro Setoyama, Ko-Ichi Kawahara, Tomoka Nagasato, Takuto Terashi, Koki Ueda, Kazuki Nakanishi, Shotaro Otsuka, Naoki Miura, Hisayo Sameshima, Kazuya Hosokawa, Yoichiro Harada, Binita Shrestha, Mika Yamamoto, Yoko Morimoto-Yamashita, Haruna Kikuchi, Ryoji Kiyama, Chinatsu Kamikokuryo, Salunya Tancharoen, Harutoshi Sakakima, Motohiro Morioka, Eiichiro Tanaka, Takashi Ito, Ikuro Maruyama
The combination of alteplase, a recombinant tissue plasminogen activator, and edaravone, an antioxidant, reportedly enhances recanalization after acute ischemic stroke. We examined the influence of edaravone on the thrombolytic efficacy of alteplase by measuring thrombolysis using a newly developed microchip-based flow-chamber assay. Rat models of embolic cerebral ischemia were treated with either alteplase or alteplase-edaravone combination therapy. The combination therapy significantly reduced the infarct volume and improved neurological deficits...
2017: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29243449/are-we-ready-for-automated-optimal-cerebral-perfusion-pressure
#16
Katia Donadello, Leonardo Gottin
No abstract text is available yet for this article.
December 14, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29241396/critical-thresholds-of-icp-derived-continuous-cerebrovascular-reactivity-indices-for-outcome-prediction-in-non-craniectomized-tbi-patients-prx-pax-and-rac
#17
Frederick Adam Zeiler, Joseph Donnelly, Peter Smieleweski, David Menon, Peter John Hutchinson, Marek Czosnyka
To compare ICP derived cerebrovascular reactivity indices in their ability to predict 6-month outcome, and to determine/compare critical thresholds related to outcome for each index, in adult non-craniectomized traumatic brain injury (TBI). Using a retrospective cohort of non-decompressive craniectomy (non-DC) TBI patients, we performed univariate and multivariate binary logistic regression outcome analysis of: pressure reactivity index (PRx), pulse amplitude index (PAx) and a newly described index calculated as the Regression coefficient between intracranial pressure (ICP) waveform Amplitude and Cerebral perfusion pressure RAC (CPP)...
December 14, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29218511/optical-monitoring-of-cerebral-microcirculation-in-neurointensive-care
#18
Peter Rejmstad, Neda Haj-Hosseini, Oscar Åneman, Karin Wårdell
Continuous optical monitoring of local cerebral microcirculation could benefit neurointensive care patients treated for subarachnoid hemorrhage (SAH). The aim of the study was to evaluate laser Doppler flowmetry (LDF) and diffuse reflectance spectroscopy (DRS) for long-term monitoring of brain microcirculation and oxygen saturation (SO2) in the neurointensive care unit (NICU). A fiber optic probe was designed for intraparenchymal use and connected to LDF and DRS for assessment of the local blood flow (perfusion and tissue reflectance (TLI)) and SO2 in the brain...
December 8, 2017: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/29217363/positional-brain-single-photon-emission-computed-tomography-findings-in-a-case-of-limb-shaking-syndrome
#19
Caroline Bund, Céline Heimburger, Valérie Wolff, Izzie Jacques Namer
An 84-year-old man, who presented lower limbs limb-shaking syndrome at orthostatism lasting a few seconds, was referred in our stroke unit. Magnetic resonance imaging showed an acute infarction in the right thalamus and the insular cortex, left extracranial carotid stenosis at 80%, and low flow in the right middle cerebral artery but did not explain limb-shaking syndrome symptomatology. We performed comparative positional brain perfusion single-photon emission computed tomography (SPECT), in the upright and in the supine position, to explore and localize hypoperfusion-endangered brain structures that may be involved in the presenting symptoms...
December 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29212807/the-independent-and-interactive-effects-of-incremental-heat-strain-orthostatic-stress-and-mild-hypohydration-on-cerebral-perfusion
#20
Rebekah A I Lucas, Luke C Wilson, Philip N Ainslie, Jui-Lin Fan, Kate N Thomas, James D Cotter
The purpose of this study was to identify the dose-dependent effects of heat strain and orthostasis (via lower-body negative pressure; LBNP), with and without mild hypohydration, on systemic function and cerebral perfusion. Eleven males (Mean ±SD: 27 ±7 y; body mass 77 ±6 kg), resting supine in a water-perfused suit, underwent progressive passive heating [0.5°C increments in core temperature (Tc, oesophageal to +2.0°C)] whilst euhydrated (EUH) or hypohydrated (HYPO, 1.5-2% body mass deficit). At each thermal state, mean cerebral artery blood velocity (MCAvmean, Transcranial Doppler), partial pressure of end-tidal carbon dioxide (PETCO2), heart rate (HR) and mean arterial blood pressure (MAP, photoplethysmography) were measured continuously during LBNP (0, -15, -30, -45 mm Hg)...
December 6, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
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