Header

UZH-Logo

Maintenance Infos

Alpha-stat versus pH-stat guided ventilation in patients with large ischemic stroke treated by hypothermia


Kollmar, R; Georgiadis, D; Schwab, S (2009). Alpha-stat versus pH-stat guided ventilation in patients with large ischemic stroke treated by hypothermia. Neurocritical Care, 10(2):173-180.

Abstract

BACKGROUND: Moderate hypothermia (MH) is a therapeutic approach for ischemic stroke as well as cardiac arrest. Two different technical strategies of ventilation during MH called alpha- and pH-stat dramatically influence cerebral blood flow (CBF). In turn this might influence neuronal damage and intracranial pressure (ICP). Therefore, effects of ventilation on CBF and ICP were measured in patients undergoing MH because of large ischemic stroke to address optimal ventilation management. METHODS: Eight patients (n = 8) with large ischemic stroke in the territory of the middle cerebral artery (MCA) were treated by MH of 33 degrees C within 24 h after symptom onset. MH was applied at least for 72 h. Each day, patients were ventilated repetitively with either alpha-stat or pH-stat for 60 min periods. Alpha-stat was applied between the measurements. ICP, CBF, and mean arterial blood pressure (MABP) were measured. The xenon clearance method was used to assess CBF at the bedside. RESULTS: There were no significant differences between ICP values for alpha-stat or pH-stat during days 1 and 2 after induction of hypothermia. However, ICP was higher in the pH- as compared to the alpha-stat group (P < 0.05) and exceeded a mean of 20 mmHg on day 3. pH-stat led to a significant increase of CBF in all measures (P < 0.05), while MABP was unaffected. CONCLUSIONS: pH-stat implies a better CBF to the injured brain, while it might be dangerous by elevating ICP in more subacute stages.

Abstract

BACKGROUND: Moderate hypothermia (MH) is a therapeutic approach for ischemic stroke as well as cardiac arrest. Two different technical strategies of ventilation during MH called alpha- and pH-stat dramatically influence cerebral blood flow (CBF). In turn this might influence neuronal damage and intracranial pressure (ICP). Therefore, effects of ventilation on CBF and ICP were measured in patients undergoing MH because of large ischemic stroke to address optimal ventilation management. METHODS: Eight patients (n = 8) with large ischemic stroke in the territory of the middle cerebral artery (MCA) were treated by MH of 33 degrees C within 24 h after symptom onset. MH was applied at least for 72 h. Each day, patients were ventilated repetitively with either alpha-stat or pH-stat for 60 min periods. Alpha-stat was applied between the measurements. ICP, CBF, and mean arterial blood pressure (MABP) were measured. The xenon clearance method was used to assess CBF at the bedside. RESULTS: There were no significant differences between ICP values for alpha-stat or pH-stat during days 1 and 2 after induction of hypothermia. However, ICP was higher in the pH- as compared to the alpha-stat group (P < 0.05) and exceeded a mean of 20 mmHg on day 3. pH-stat led to a significant increase of CBF in all measures (P < 0.05), while MABP was unaffected. CONCLUSIONS: pH-stat implies a better CBF to the injured brain, while it might be dangerous by elevating ICP in more subacute stages.

Statistics

Citations

17 citations in Web of Science®
17 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

1 download since deposited on 22 Jun 2009
0 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:22 Jun 2009 10:25
Last Modified:06 Dec 2017 17:20
Publisher:Springer
ISSN:1541-6933
Additional Information:The original publication is available at www.springerlink.com
Publisher DOI:https://doi.org/10.1007/s12028-008-9162-z
PubMed ID:19002612

Download