Measurement of nitric oxide and brain tissue oxygen tension in patients after severe subarachnoid hemorrhage.
OBJECTIVE
Nitric oxide (NO), one of the most powerful endogenous vasodilators, is thought to play a major role in the development of delayed vasospasm in patients with subarachnoid hemorrhage (SAH). However, the role of the production of cerebral NO in patients with SAH is not known. In other SAH studies, NO metabolites such as nitrite and nitrate have been demonstrated to be decreased in cerebrospinal fluid and in plasma.


METHODS
In this study, a microdialysis probe was used, along with a multiparameter sensor, to measure NO metabolites, brain tissue oxygen tension, brain tissue carbon dioxide tension, and pH in the cortex of patients with severe SAH who were at risk for developing secondary brain damage and vasospasm. NO metabolites, glucose, and lactate were analyzed in the dialysates to determine the time course of NO metabolite changes and to test the interrelationship between the analytes and clinical variables.


RESULTS
Brain tissue oxygen tension was strongly correlated to dialysate nitrate and nitrite (r2 = 0.326; P < 0.001); however, no correlation was noted between brain tissue oxygen tension and NO metabolites in cerebrospinal fluid (r2 = 0.018; P = 0.734). No significant correlation between NO production, brain tissue carbon dioxide tension, and dialysate glucose and lactate was observed.


CONCLUSIONS
Cerebral ischemia and compromised substrate delivery are often responsible for high morbidity rates and poor outcomes after SAH. The relationship between brain tissue oxygen and cerebral NO metabolites that we demonstrate suggests that substrate delivery and NO are linked in the pathophysiology of vasospasm after SAH.
Khaldi
A
A
Division of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0631, USA.
Zauner
A
A
Reinert
M
M
Woodward
J J
JJ
Bullock
M R
MR
D000328:Adult; D000368:Aged; D001921:Brain / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D009566:Nitrates / Q000378:metabolism; D009569:Nitric Oxide / Q000134:cerebrospinal fluid / Q000378:metabolism*; D009573:Nitrites / Q000378:metabolism; D010100:Oxygen / Q000378:metabolism*; D010313:Partial Pressure; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000378:metabolism* / Q000503:physiopathology
D009566:Nitrates; D009573:Nitrites; D009569:Nitric Oxide; D010100:Oxygen