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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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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 |
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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 |
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