Splanchnic ischemia and gut permeability after acute brain injury secondary to intracranial hemorrhage.
BACKGROUND
Splanchnic ischemia (SI) and increased gut permeability (GP) have been described in acute brain injury (ABI), although their incidence and relation to the type and severity of injury are uncertain. The aim of this study was to evaluate the incidence of both abnormalities in a series of patients with severe ABI secondary to intracranial hemorrhage (ICH) managed with a resuscitation protocol pursuing adequate cerebral and systemic hemodynamics.


METHODS
Eight patients with severe ABI secondary to ICH were admitted to the ICU and were mechanically ventilated and monitored with intracranial pressure measurement, jugular bulb venous oxygen saturation, arterial lactate concentration and gastric tonometry. All patients were managed actively to maintain adequate blood and cerebral perfusion pressures with a protocol based on aggressive fluid resuscitation prior to vasoactive drugs administration. GP was assessed using the lactulose/mannitol test (LMT). Values were recorded during the first 7 days of hospital stay.


RESULTS
Arterial lactate concentration was within the normal range (1.9 +/- 0.5 mmol/l) in all patients. Upon admission, the mean pCO(2) gap was 8.2 +/- 4.3 mmHg (1.09 +/- 0.57 kPa) with an intramucosal pH of 7.4 +/- 0.1. All patients had an abnormal LMT (0.066 +/- 0.055) compared with 19 healthy volunteers (0.025 +/- 0.004) (p < 0.05, Mann Whitney test).


CONCLUSIONS
Splanchnic ischemia is uncommon among patients with acute brain injury secondary to intracranial hemorrhage, provided they are adequately resuscitated with a protocol based mainly on fluids to achieve an adequate CPP. Gut hyperpermeability is commonly present, despite the absence of splanchnic ischemia.
Hernández
Glenn
G
Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367 Tercer Piso, Santiago Centro, Chile. glenn@med.puc.cl
Hasbun
Pablo
P
Velasco
Nicolas
N
Wainstein
Carol
C
Bugedo
Guillermo
G
Bruhn
Alejandro
A
Klaassen
Julieta
J
Castillo
Luis
L
D000368:Aged; D001930:Brain Injuries / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D003422:Critical Care; D005260:Female; D006801:Humans; D015994:Incidence; D007408:Intestinal Absorption / Q000502:physiology*; D007413:Intestinal Mucosa / Q000098:blood supply* / Q000378:metabolism; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D007511:Ischemia / Q000453:epidemiology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D016896:Treatment Outcome