Cargando…

Association of Arterial Metabolic Content with Cerebral Blood Flow Regulation and Cerebral Energy Metabolism–A Multimodality Analysis in Aneurysmal Subarachnoid Hemorrhage

BACKGROUND: In this study, the association of the arterial content of oxygen, carbon dioxide, glucose, and lactate with cerebral pressure reactivity, energy metabolism and clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH) was investigated. METHODS: In this retrospective study, 60 pati...

Descripción completa

Detalles Bibliográficos
Autores principales: Svedung Wettervik, Teodor, Hånell, Anders, Howells, Timothy, Ronne-Engström, Elisabeth, Enblad, Per, Lewén, Anders
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9548938/
https://www.ncbi.nlm.nih.gov/pubmed/35171061
http://dx.doi.org/10.1177/08850666221080054
_version_ 1784805550995800064
author Svedung Wettervik, Teodor
Hånell, Anders
Howells, Timothy
Ronne-Engström, Elisabeth
Enblad, Per
Lewén, Anders
author_facet Svedung Wettervik, Teodor
Hånell, Anders
Howells, Timothy
Ronne-Engström, Elisabeth
Enblad, Per
Lewén, Anders
author_sort Svedung Wettervik, Teodor
collection PubMed
description BACKGROUND: In this study, the association of the arterial content of oxygen, carbon dioxide, glucose, and lactate with cerebral pressure reactivity, energy metabolism and clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH) was investigated. METHODS: In this retrospective study, 60 patients with aSAH, treated at the neurointensive care (NIC), Uppsala University Hospital, Sweden, between 2016 and 2021 with arterial blood gas (ABG), intracranial pressure, and cerebral microdialysis (MD) monitoring were included. The first 10 days were divided into an early phase (day 1 to 3) and a vasospasm phase (day 4 to 10). RESULTS: Higher arterial lactate was independently associated with higher/worse pressure reactivity index (PRx) in the early phase (β = 0.32, P = .02), whereas higher pO(2) had the opposite association in the vasospasm phase (β = −0.30, P = .04). Arterial glucose and pCO(2) were not associated with PRx. Higher arterial lactate (β = 0.29, P = .05) was independently associated with higher MD-glucose in the vasospasm phase, whereas higher pO(2) had the opposite association in the vasospasm phase (β = −0.33, P = .03). Arterial glucose and pCO(2) were not associated with MD-glucose. Higher pCO(2) in the early phase, lower arterial glucose in both phases, and lower arterial lactate in the vasospasm phase were associated (P < .05) with better clinical outcome. CONCLUSIONS: Arterial variables associated with more vasoconstriction (higher pO(2) and lower arterial lactate) were associated with better cerebral pressure reactivity, but worse energy metabolism. In severe aSAH, when cerebral large-vessel vasospasm with exhausted distal vasodilation is common, more vasoconstriction could increase distal vasodilatory reserve and pressure reactivity, but also reduce cerebral blood flow and metabolic supply. The MD may be useful to monitor the net effects on cerebral metabolism in PRx-targeted NIC.
format Online
Article
Text
id pubmed-9548938
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-95489382022-10-11 Association of Arterial Metabolic Content with Cerebral Blood Flow Regulation and Cerebral Energy Metabolism–A Multimodality Analysis in Aneurysmal Subarachnoid Hemorrhage Svedung Wettervik, Teodor Hånell, Anders Howells, Timothy Ronne-Engström, Elisabeth Enblad, Per Lewén, Anders J Intensive Care Med Original Research BACKGROUND: In this study, the association of the arterial content of oxygen, carbon dioxide, glucose, and lactate with cerebral pressure reactivity, energy metabolism and clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH) was investigated. METHODS: In this retrospective study, 60 patients with aSAH, treated at the neurointensive care (NIC), Uppsala University Hospital, Sweden, between 2016 and 2021 with arterial blood gas (ABG), intracranial pressure, and cerebral microdialysis (MD) monitoring were included. The first 10 days were divided into an early phase (day 1 to 3) and a vasospasm phase (day 4 to 10). RESULTS: Higher arterial lactate was independently associated with higher/worse pressure reactivity index (PRx) in the early phase (β = 0.32, P = .02), whereas higher pO(2) had the opposite association in the vasospasm phase (β = −0.30, P = .04). Arterial glucose and pCO(2) were not associated with PRx. Higher arterial lactate (β = 0.29, P = .05) was independently associated with higher MD-glucose in the vasospasm phase, whereas higher pO(2) had the opposite association in the vasospasm phase (β = −0.33, P = .03). Arterial glucose and pCO(2) were not associated with MD-glucose. Higher pCO(2) in the early phase, lower arterial glucose in both phases, and lower arterial lactate in the vasospasm phase were associated (P < .05) with better clinical outcome. CONCLUSIONS: Arterial variables associated with more vasoconstriction (higher pO(2) and lower arterial lactate) were associated with better cerebral pressure reactivity, but worse energy metabolism. In severe aSAH, when cerebral large-vessel vasospasm with exhausted distal vasodilation is common, more vasoconstriction could increase distal vasodilatory reserve and pressure reactivity, but also reduce cerebral blood flow and metabolic supply. The MD may be useful to monitor the net effects on cerebral metabolism in PRx-targeted NIC. SAGE Publications 2022-02-16 2022-11 /pmc/articles/PMC9548938/ /pubmed/35171061 http://dx.doi.org/10.1177/08850666221080054 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Svedung Wettervik, Teodor
Hånell, Anders
Howells, Timothy
Ronne-Engström, Elisabeth
Enblad, Per
Lewén, Anders
Association of Arterial Metabolic Content with Cerebral Blood Flow Regulation and Cerebral Energy Metabolism–A Multimodality Analysis in Aneurysmal Subarachnoid Hemorrhage
title Association of Arterial Metabolic Content with Cerebral Blood Flow Regulation and Cerebral Energy Metabolism–A Multimodality Analysis in Aneurysmal Subarachnoid Hemorrhage
title_full Association of Arterial Metabolic Content with Cerebral Blood Flow Regulation and Cerebral Energy Metabolism–A Multimodality Analysis in Aneurysmal Subarachnoid Hemorrhage
title_fullStr Association of Arterial Metabolic Content with Cerebral Blood Flow Regulation and Cerebral Energy Metabolism–A Multimodality Analysis in Aneurysmal Subarachnoid Hemorrhage
title_full_unstemmed Association of Arterial Metabolic Content with Cerebral Blood Flow Regulation and Cerebral Energy Metabolism–A Multimodality Analysis in Aneurysmal Subarachnoid Hemorrhage
title_short Association of Arterial Metabolic Content with Cerebral Blood Flow Regulation and Cerebral Energy Metabolism–A Multimodality Analysis in Aneurysmal Subarachnoid Hemorrhage
title_sort association of arterial metabolic content with cerebral blood flow regulation and cerebral energy metabolism–a multimodality analysis in aneurysmal subarachnoid hemorrhage
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9548938/
https://www.ncbi.nlm.nih.gov/pubmed/35171061
http://dx.doi.org/10.1177/08850666221080054
work_keys_str_mv AT svedungwettervikteodor associationofarterialmetaboliccontentwithcerebralbloodflowregulationandcerebralenergymetabolismamultimodalityanalysisinaneurysmalsubarachnoidhemorrhage
AT hanellanders associationofarterialmetaboliccontentwithcerebralbloodflowregulationandcerebralenergymetabolismamultimodalityanalysisinaneurysmalsubarachnoidhemorrhage
AT howellstimothy associationofarterialmetaboliccontentwithcerebralbloodflowregulationandcerebralenergymetabolismamultimodalityanalysisinaneurysmalsubarachnoidhemorrhage
AT ronneengstromelisabeth associationofarterialmetaboliccontentwithcerebralbloodflowregulationandcerebralenergymetabolismamultimodalityanalysisinaneurysmalsubarachnoidhemorrhage
AT enbladper associationofarterialmetaboliccontentwithcerebralbloodflowregulationandcerebralenergymetabolismamultimodalityanalysisinaneurysmalsubarachnoidhemorrhage
AT lewenanders associationofarterialmetaboliccontentwithcerebralbloodflowregulationandcerebralenergymetabolismamultimodalityanalysisinaneurysmalsubarachnoidhemorrhage