title: Cerebral blood flow augmentation in patients with severe subarachnoid haemorrhage.
abstract: Following aneurysmal subarachnoid haemorrhage (SAH), cerebral blood flow (CBF) may be reduced, resulting in poor outcome due to cerebral ischaemia and subsequent stroke. Hypertonic saline (HS) is known to be effective in reducing intracranial pressure (ICP). We have previously shown a 20-50% increase in CBF in ischaemic regions after intravenous infusion of HS. This study aims to determine the effect of HS on CBF augmentation, substrate delivery and metabolism. Continuous monitoring of arterial blood pressure (ABP), ICP, cerebral perfusion pressure (CPP), brain tissue oxygen (PbO2), middle cerebral artery flow velocity (FV), and microdialysis was performed in 14 poor grade SAH patients. Patients were given an infusion of 23.5% HS, and quantified xenon computerised tomography scanning (XeCT) was carried out before and after the infusion in 9 patients. The results showed a significant increase in ABP, CPP, FV and PbO2, and a significant decrease in ICP (p < 0.05). Nine patients showed a decrease in lactate-pyruvate ratio at 60 minutes following HS infusion. These results show that HS safely and effectively augments CBF in patients with poor grade SAH and significantly improves cerebral oxygenation. An improvement in cerebral metabolic status in terms of lactate-pyruvate ratio is also associated with HS infusion.
authors.affiliation: University Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK. pga20@medschl.cam.ac.uk
authors.forename: P G
authors.initials: PG
authors.lastname: Al-Rawi
authors.forename: D
authors.initials: D
authors.lastname: Zygun
authors.forename: M Y
authors.initials: MY
authors.lastname: Tseng
authors.forename: P J A
authors.initials: PJ
authors.lastname: Hutchinson
authors.forename: B F
authors.initials: BF
authors.lastname: Matta
authors.forename: P J
authors.initials: PJ
authors.lastname: Kirkpatrick
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D012462:Saline Solution, Hypertonic