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Global cerebral blood flow and CPP after severe head injury: a xenon-CT study

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Abstract

Objective

To evaluate the association between global cerebral blood flow and different cerebral perfusion pressure ranges in severe head injury.

Design

A retrospective study

Setting

Neurosurgical and trauma patients in an intensive care unit in a regional hospital.

Patients and participants

Out of a series of 237 consecutive patients with severe head injuries (GCS ≤ 8), 162 were submitted to ICP monitoring and 89 of them underwent 180 xenon-CT studies and cerebral perfusion pressure (CPP) measurement. The xenon-CT studies did not include any unsalvageable patients nor any mistakenly diagnosed as severe on entry.

Interventions

None.

Measurements and results

Most (95.6%) of xenon-CT studies were obtained with CPP values within the 50–90 mmHg range. Perfusion data were grouped according to CPP values: (1) below 50 mmHg, (2) 50–60 mmHg, (3) 60–70 mmHg, (4) above 70 mmHg. Global cerebral blood flow did not differ among the groups (p = 0.49). No differences in physiological variables were found among the CPP groups, except for intracranial pressure, higher in the group with CPP below 50 mmHg, and mean arterial pressure, higher in the CPP above 70 mmHg group (p < 0.0001). No differences were found for cerebral metabolic rate of oxygen and lactate.

Conclusions

There was little correlation between CPP values and global cerebral blood flow levels in our selected patients, probably because pressure autoregulation was preserved. Global metabolism measurements were constant within the groups, suggesting that in patients with controlled physiological variables an interplay between cerebral blood flow and metabolism might be more relevant than the relationship between CPP and cerebral blood flow.

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Acknowledgements

We would like to thank Nicola Latronico (Istituto di Anestesia e Rianimazione, Brescia) for his useful comments, Franco Servadei (U. O. Neurochirurgia per la Traumatologia, Cesena) for introducing the xenon-CT technique in our hospital, Rosario Pascarella (U. O. Neuroradiologia, Cesena) for his contribution to the improvement of the quality of xenon-CT studies, and Wilma Benedettini, Costanza Martino (both U. O. Anestesia e Rianimazione, Cesena), Giuliano Giuliani and Elide Gardini (both U. O. Neurochirurgia per la Neurotraumatologia, Cesena) for data regarding patient outcome.

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Authors and Affiliations

  1. U. O. Anestesia e Rianimazione, Ospedale M. Bufalini, viale Ghirotti 286, 47023, Cesena, Italy

    Arturo Chieregato, Alessandra Tanfani, Christian Compagnone, Claudia Turrini, Federica Sarpieri, Maurizio Ravaldini & Luigi Targa

  2. U. O. Neuroradiologia, Ospedale S. Anna, Ferrara, Italy

    Enrico Fainardi

Authors
  1. Arturo Chieregato
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  2. Alessandra Tanfani
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  3. Christian Compagnone
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  4. Claudia Turrini
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  5. Federica Sarpieri
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  6. Maurizio Ravaldini
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  7. Luigi Targa
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  8. Enrico Fainardi
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Correspondence to Arturo Chieregato.

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Chieregato, A., Tanfani, A., Compagnone, C. et al. Global cerebral blood flow and CPP after severe head injury: a xenon-CT study. Intensive Care Med 33, 856–862 (2007). https://doi.org/10.1007/s00134-007-0604-4

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  • DOI: https://doi.org/10.1007/s00134-007-0604-4

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