Abstract:
OBJECTIVE:To examine the accuracy of brain multimodal monitoring-consisting of intracranial pressure, brain tissue PO2, and cerebral microdialysis--in detecting cerebral hypoperfusion in patients with severe traumatic brain injury. DESIGN:Prospective single-center study. PATIENTS:Patients with severe traumatic brain injury. SETTING:Medico-surgical ICU, university hospital. INTERVENTION:Intracranial pressure, brain tissue PO2, and cerebral microdialysis monitoring (right frontal lobe, apparently normal tissue) combined with cerebral blood flow measurements using perfusion CT. MEASUREMENTS AND MAIN RESULTS:Cerebral blood flow was measured using perfusion CT in tissue area around intracranial monitoring (regional cerebral blood flow) and in bilateral supra-ventricular brain areas (global cerebral blood flow) and was matched to cerebral physiologic variables. The accuracy of intracranial monitoring to predict cerebral hypoperfusion (defined as an oligemic regional cerebral blood flow < 35 mL/100 g/min) was examined using area under the receiver-operating characteristic curves. Thirty perfusion CT scans (median, 27 hr [interquartile range, 20-45] after traumatic brain injury) were performed on 27 patients (age, 39 yr [24-54 yr]; Glasgow Coma Scale, 7 [6-8]; 24/27 [89%] with diffuse injury). Regional cerebral blood flow correlated significantly with global cerebral blood flow (Pearson r = 0.70, p < 0.01). Compared with normal regional cerebral blood flow (n = 16), low regional cerebral blood flow (n = 14) measurements had a higher proportion of samples with intracranial pressure more than 20 mm Hg (13% vs 30%), brain tissue PO2 less than 20 mm Hg (9% vs 20%), cerebral microdialysis glucose less than 1 mmol/L (22% vs 57%), and lactate/pyruvate ratio more than 40 (4% vs 14%; all p < 0.05). Compared with intracranial pressure monitoring alone (area under the receiver-operating characteristic curve, 0.74 [95% CI, 0.61-0.87]), monitoring intracranial pressure + brain tissue PO2 (area under the receiver-operating characteristic curve, 0.84 [0.74-0.93]) or intracranial pressure + brain tissue PO2+ cerebral microdialysis (area under the receiver-operating characteristic curve, 0.88 [0.79-0.96]) was significantly more accurate in predicting low regional cerebral blood flow (both p < 0.05). CONCLUSION:Brain multimodal monitoring-including intracranial pressure, brain tissue PO2, and cerebral microdialysis--is more accurate than intracranial pressure monitoring alone in detecting cerebral hypoperfusion at the bedside in patients with severe traumatic brain injury and predominantly diffuse injury.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Bouzat P,Marques-Vidal P,Zerlauth JB,Sala N,Suys T,Schoettker P,Bloch J,Daniel RT,Levivier M,Meuli R,Oddo Mdoi
10.1097/CCM.0000000000000720subject
Has Abstractpub_date
2015-02-01 00:00:00pages
445-52issue
2eissn
0090-3493issn
1530-0293journal_volume
43pub_type
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198705000-00013
更新日期:1987-05-01 00:00:00
abstract::The Pediatric Risk of Mortality (PRISM) score was developed from the Physiologic Stability Index (PSI) to reduce the number of physiologic variables required for pediatric ICU (PICU) mortality risk assessment and to obtain an objective weighting of the remaining variables. Univariate and multivariate statistical techn...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/00003246-198811000-00006
更新日期:1988-11-01 00:00:00
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doi:10.1097/CCM.0b013e31819ced3a
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pub_type: 杂志文章
doi:10.1097/00003246-199902000-00031
更新日期:1999-02-01 00:00:00
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doi:10.1097/CCM.0000000000004642
更新日期:2020-12-01 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000295304.99946.58
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND AND METHODS:To determine the effects of reduced cerebral perfusion pressures produced by hemorrhage alone or in combination with intracranial hypertension on thromboxane A2 (TxA2) production, we undertook a randomized study in 38 anesthetized, mongrel dogs. Animals were subjected to 30 mins of hemorrhagic sh...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199104000-00013
更新日期:1991-04-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200009001-00003
更新日期:2000-09-01 00:00:00
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doi:10.1097/CCM.0b013e3181760e5d
更新日期:2008-06-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/00003246-198609000-00010
更新日期:1986-09-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000183157.15533.4c
更新日期:2005-10-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/CCM.0000000000004326
更新日期:2020-06-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/00003246-200207000-00018
更新日期:2002-07-01 00:00:00
abstract::Gastric mucosal damage occurs in critically ill patients in intensive care units and develops in the setting of severe physiologic stress. Within 24 hrs of admission to the intensive care unit, 75% to 100% of critically ill patients demonstrate evidence of stress-related mucosal disease. Stress ulcers present a risk o...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200206001-00002
更新日期:2002-06-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00008
更新日期:1999-11-01 00:00:00
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pub_type: 临床试验,杂志文章
doi:10.1097/01.CCM.0000063448.98777.EF
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that the lectin-like domain of tumor necrosis factor, mimicked by the TIP peptide, can improve lung function after unilateral orthotopic lung isotransplantation. Because of a lack of a specific treatment for ischemia reperfusion-mediated lung injury, accompanied by a disrupted barrier i...
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pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181cdf725
更新日期:2010-03-01 00:00:00
abstract::In 179 healthy boys and girls, the relationship between body surface area (S) in dm2 and body weight (bw) in kg was investigated. The body surface was calculated from the DuBois and DuBois formula. For infants below 20 kg, the relationship followed the regression equation S=3.6kg + 9; r=0.996. For infants with bw betw...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198111000-00005
更新日期:1981-11-01 00:00:00
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doi:10.1097/CCM.0000000000000125
更新日期:2014-05-01 00:00:00
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doi:10.1097/00003246-200301000-00015
更新日期:2003-01-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-200204000-00005
更新日期:2002-04-01 00:00:00
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更新日期:1994-02-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318195865a
更新日期:2009-02-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/00003246-200204000-00025
更新日期:2002-04-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199801000-00023
更新日期:1998-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182a639fd
更新日期:2014-01-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
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更新日期:2004-03-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2013-06-01 00:00:00
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更新日期:2016-04-01 00:00:00