IngentaConnect Cerebral blood flow, oxidative metabolism and cerebrovascular car...

Authors: Møller, K.¹; Strauss, G. I.²; Thomsen, G.³; Larsen, F. S.²; Holm, S.⁴; Sperling, B. K.³; Skinhøj, P.¹; Knudsen, G. M.³

Source: Acta Anaesthesiologica Scandinavica, Volume 46, Number 5, May 2002 , pp. 567-578(12)

Publisher: Blackwell Publishing

Abstract:

Background:

The optimal arterial carbon dioxide tension (P_aCO₂) in patients with acute bacterial meningitis (ABM) is unknown and controversial. The objective of this study was to measure global cerebral blood flow (CBF), cerebrovascular CO₂ reactivity (CO₂R), and cerebral metabolic rates (CMR) of oxygen (O₂), glucose (glu), and lactate (lac), in patients with ABM and compare the results to those obtained in healthy volunteers. Methods:

We studied 19 patients (17 of whom were sedated) with ABM and eight healthy volunteers (controls). CBF was measured during baseline ventilation and hyperventilation with single-photon emission computed tomography (SPECT) (14 patients) and/or the Kety-Schmidt technique (KS) (11 patients and all controls). In KS studies, CMR was measured by multiplying the arterial to jugular venous concentration difference (a-v D) by CBF. Results:

CBF did not differ significantly among groups, although a larger variation was seen in patients than in controls. CO₂R was not significantly different among groups. At baseline, patients had significantly lower a-v DO₂, CMR(O₂), CMR(glu), and CMR(lac) than controls. CMR(O₂) did not change between hyperventilation compared to baseline ventilation, whereas CMR(glu) increased. Conclusion:

In patients with acute bacterial meningitis, we found variable levels of CBF and cerebrovascular CO₂ reactivity, a low a-v DO₂, low cerebral metabolic rates of oxygen and glucose, and a cerebral lactate efflux. In these patients, a ventilation strategy guided by jugular bulb oximetry and/or repeated CBF measurements may be more optimal in terms of cerebral oxygenation than a strategy aiming at identical levels of P_aCO₂ for all patients.

Keywords: Bacterial meningitis; brain; hyperventilation; metabolism; regional blood flow; tomography; emission-computed; single-photon

Document Type: Research article

DOI: 10.1034/j.1399-6576.2002.460515.x

Affiliations: 1: Infectious Diseases, 2: Hepatology, 3: Neurology and 4: Clinical Physics & Nuclear Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark

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Cerebral blood flow, oxidative metabolism and cerebrovascular carbon dioxide reactivity in patients with acute bacterial meningitis