[Cerebral hemometabolism: variability in the acute phase of traumatic coma].
OBJECTIVE
to evaluate the interrelationships between cerebral and systemic hemometabolic alterations in patients with severe traumatic brain injury managed according to a standardized therapeutic protocol.


METHODS
prospective, interventional study in patients with traumatic coma.


METHODS
a general Intensive Care Unit in a teaching hospital.


METHODS
twenty-seven patients (21M e 6F), aging 14 - 58 years, with severe acute brain trauma, presenting with three to eight points on the Glasgow Coma Scale, were prospectively evaluated according to a cumulative protocol for the management of acute intracranial hypertension, where intracranial pressure (ICP) and cerebral extraction of oxygen (CEO2) were routinely measured. Hemometabolic interrelationships involving mean arterial pressure (MAP), ICP, arterial carbon dioxide tension (PaCO2), CEO2, cerebral perfusion pressure (CPP) and systemic extraction of oxygen (SEO2) were analyzed.


METHODS
routine therapeutic procedures.


RESULTS
no correlation was found between CEO2 and CPP (r = -0.07; p = 0.41). There was a significant negative correlation between PaCO2 and CEO2 (r = -0.24; p = 0.005) and a positive correlation between SEO2 and CEO2 (r = 0.24; p = 0.01). The mortality rate in this group of patients was 25.9% (7/27).


CONCLUSIONS
1) CPP and CEO2 are unrelated; 2) CEO2 and PaCO2 are closely related; 3) during optimized hyperventilation, CEO2 and SEO2 are coupled.
Falcão
A L
AL
Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. aefalcao@hotmail.com
Araújo
S
S
Dragosavac
D
D
Terzi
R G
RG
Thiesen
R A
RA
Cintra
E A
EA
Sardinha
L A
LA
Capone Neto
A
A
Dantas Filho
V P
VP
Quagliato
E M
EM
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D002245:Carbon Dioxide / Q000378:metabolism; D002560:Cerebrovascular Circulation; D002985:Clinical Protocols; D003128:Coma / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000097:blood / Q000503:physiopathology; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011446:Prospective Studies
D002245:Carbon Dioxide; D010100:Oxygen