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Body temperature affects cerebral hemodynamics in acutely brain injured patients: an observational transcranial color-coded duplex sonography study


Stretti, Federica; Gotti, Miriam; Pifferi, Silvia; Brandi, Giovanna; Annoni, Federico; Stocchetti, Nino (2014). Body temperature affects cerebral hemodynamics in acutely brain injured patients: an observational transcranial color-coded duplex sonography study. Critical Care, 18(5):552.

Abstract

IntroductionTemperature changes are common in patients in a neurosurgical intensive care unit (NICU): fever is frequent among severe cases and hypothermia is used after cardiac arrest and is currently being tested in clinical trials to lower intracranial pressure (ICP). This study investigated cerebral hemodynamics when body temperature varies in acute brain injured patients.MethodsWe enrolled 26 patients, 14 with acute brain injury who developed fever and were given antipyretic therapy (defervescence group) and 12 who underwent an intracranial neurosurgical procedure and developed hypothermia in the operating room; once admitted to the NICU, still under anesthesia, they were re-warmed before waking (re-warming group). We measured cerebral blood flow velocity (CBF-V) and pulsatility index (PI) at the middle cerebral artery using transcranial color-coded duplex sonography (TCCDS).ResultsIn the defervescence group mean CBF-V decreased from 75¿±¿26 (95% CI 65 to 85) to 70¿±¿22 cm/s (95% CI 61 to 79) (P¿=¿0.04); the PI also fell, from 1.36¿±¿0.33 (95% CI 1.23 to 1.50) to 1.16¿±¿0.26 (95% CI 1.05 to 1.26) (P¿=¿0.0005). In the subset of patients with ICP monitoring, ICP dropped from 16¿±¿8 to 12¿±¿6 mmHg (P¿=¿0.003). In the re-warming group mean CBF-V increased from 36¿±¿10 (95% CI 31 to 41) to 39¿±¿13 (95% CI 33 to 45) cm/s (P¿=¿0.04); the PI rose from 0.98¿±¿0.14 (95% CI 0.91 to 1.04) to 1.09¿±¿0.22 (95% CI 0.98 to 1.19) (P¿=¿0.02).ConclusionsBody temperature affects cerebral hemodynamics as evaluated by TCCDS; when temperature rises, CBF-V increases in parallel, and viceversa when temperature decreases. When cerebral compliance is reduced and compensation mechanisms are exhausted, even modest temperature changes can greatly affect ICP.

Abstract

IntroductionTemperature changes are common in patients in a neurosurgical intensive care unit (NICU): fever is frequent among severe cases and hypothermia is used after cardiac arrest and is currently being tested in clinical trials to lower intracranial pressure (ICP). This study investigated cerebral hemodynamics when body temperature varies in acute brain injured patients.MethodsWe enrolled 26 patients, 14 with acute brain injury who developed fever and were given antipyretic therapy (defervescence group) and 12 who underwent an intracranial neurosurgical procedure and developed hypothermia in the operating room; once admitted to the NICU, still under anesthesia, they were re-warmed before waking (re-warming group). We measured cerebral blood flow velocity (CBF-V) and pulsatility index (PI) at the middle cerebral artery using transcranial color-coded duplex sonography (TCCDS).ResultsIn the defervescence group mean CBF-V decreased from 75¿±¿26 (95% CI 65 to 85) to 70¿±¿22 cm/s (95% CI 61 to 79) (P¿=¿0.04); the PI also fell, from 1.36¿±¿0.33 (95% CI 1.23 to 1.50) to 1.16¿±¿0.26 (95% CI 1.05 to 1.26) (P¿=¿0.0005). In the subset of patients with ICP monitoring, ICP dropped from 16¿±¿8 to 12¿±¿6 mmHg (P¿=¿0.003). In the re-warming group mean CBF-V increased from 36¿±¿10 (95% CI 31 to 41) to 39¿±¿13 (95% CI 33 to 45) cm/s (P¿=¿0.04); the PI rose from 0.98¿±¿0.14 (95% CI 0.91 to 1.04) to 1.09¿±¿0.22 (95% CI 0.98 to 1.19) (P¿=¿0.02).ConclusionsBody temperature affects cerebral hemodynamics as evaluated by TCCDS; when temperature rises, CBF-V increases in parallel, and viceversa when temperature decreases. When cerebral compliance is reduced and compensation mechanisms are exhausted, even modest temperature changes can greatly affect ICP.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Intensive Care Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:14 October 2014
Deposited On:05 Feb 2015 14:08
Last Modified:03 Aug 2017 16:39
Publisher:BioMed Central
ISSN:1364-8535
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1186/s13054-014-0552-7
PubMed ID:25311035

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