Cerebral hemodynamic response to CO2 after severe head injury: clinical and prognostic implications.
OBJECTIVE
To study the cerebrovascular reactivity to CO2 after severe head injury to establish the clinical and prognostic relevance of CO2 reactivity.


METHODS
Cerebrovascular reactivity to CO2 was studied in 20 patients with severe head injuries at 3.0+/-1.8 days after trauma onset. Two cerebral blood flow studies were performed to measure CO2 reactivity: the first study in a condition of normocapnia and the second study in a condition of relative hypocapnia.


RESULTS
Global reactivity was superimposable to that found in awake, normocapnic subjects and did not correlate with age and Glasgow Coma Scale score but was dependent on the type of brain lesion. Moreover, reactivity correlated with outcome in patients studied after the first 3 days after trauma.


CONCLUSIONS
Our data suggest that cerebrovascular reactivity is (a) almost preserved after a severe head injury; (b) significantly influenced by type of brain lesion; (c) prognostically relevant only in patients studied after the first 3 days after trauma.
Paolin
A
A
Anaesthesia and Critical Care Department, S. Maria dei Battuti Hospital, Treviso, Italy.
Rodriguez
G
G
Betetto
M
M
Simini
G
G
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000378:metabolism*; D002560:Cerebrovascular Circulation; D006259:Craniocerebral Trauma / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics; D006801:Humans; D016857:Hypocapnia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D013997:Time Factors
D002245:Carbon Dioxide