Body temperature affects cerebral hemodynamics in acutely brain injured patients: an observational transcranial color-coded duplex sonography studyReport as inadecuate




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Critical Care

, 18:552

First Online: 14 October 2014Received: 15 April 2014Accepted: 23 September 2014

Abstract

IntroductionTemperature changes are common in patients in a neurosurgical intensive care unit NICU: fever is frequent among severe cases and hypothermia is used after cardiac arrest and is currently being tested in clinical trials to lower intracranial pressure ICP. This study investigated cerebral hemodynamics when body temperature varies in acute brain injured patients.

MethodsWe enrolled 26 patients, 14 with acute brain injury who developed fever and were given antipyretic therapy defervescence group and 12 who underwent an intracranial neurosurgical procedure and developed hypothermia in the operating room; once admitted to the NICU, still under anesthesia, they were re-warmed before waking re-warming group. We measured cerebral blood flow velocity CBF-V and pulsatility index PI at the middle cerebral artery using transcranial color-coded duplex sonography TCCDS.

ResultsIn the defervescence group mean CBF-V decreased from 75 ± 26 95% CI 65 to 85 to 70 ± 22 cm-s 95% CI 61 to 79 P = 0.04; the PI also fell, from 1.36 ± 0.33 95% CI 1.23 to 1.50 to 1.16 ± 0.26 95% CI 1.05 to 1.26 P = 0.0005. In the subset of patients with ICP monitoring, ICP dropped from 16 ± 8 to 12 ± 6 mmHg P = 0.003. In the re-warming group mean CBF-V increased from 36 ± 10 95% CI 31 to 41 to 39 ± 13 95% CI 33 to 45 cm-s P = 0.04; the PI rose from 0.98 ± 0.14 95% CI 0.91 to 1.04 to 1.09 ± 0.22 95% CI 0.98 to 1.19 P = 0.02.

ConclusionsBody temperature affects cerebral hemodynamics as evaluated by TCCDS; when temperature rises, CBF-V increases in parallel, and viceversa when temperature decreases. When cerebral compliance is reduced and compensation mechanisms are exhausted, even modest temperature changes can greatly affect ICP.

AbbreviationsCBFcerebral blood flow

CBF-Vcerebral blood flow velocity

CPPcerebral perfusion pressure

ICPintracranial pressure

MAPmean arterial pressure

MCAmiddle cerebral artery

NICUneurosurgical intensive care unit

PIpulsatility index

SjO2oxygen saturation in the jugular vein

Tbrainbrain temperature

TCCDStranscranial color-coded duplex sonography

Tcorecore body temperature

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0552-7 contains supplementary material, which is available to authorized users.

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Author: Federica Stretti - Miriam Gotti - Silvia Pifferi - Giovanna Brandi - Federico Annoni - Nino Stocchetti

Source: https://link.springer.com/







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