Summary
Following aneurysmal subarachnoid haemorrhage (SAH), cerebral blood flow (CBF) may be reduced, resulting in poor outcome due to cerebral ischaemia and subsequent stroke. Hypertonic saline (HS) is known to be effective in reducing intracranial pressure (ICP) [16]. We have previously shown a 20–50% increase in CBF in ischaemic regions after intravenous infusion of HS [17]. This study aims to determine the effect of HS on CBF augmentation, substrate delivery and metabolism.
Continuous monitoring of arterial blood pressure (ABP), ICP, cerebral perfusion pressure (CPP), brain tissue oxygen (PbO2), middle cerebral artery flow velocity (FV), and microdialysis was performed in 14 poor grade SAH patients. Patients were given an infusion of 23.5% HS, and quantified xenon computerised tomography scanning (XeCT) was carried out before and after the infusion in 9 patients.
The results showed a significant increase in ABP, CPP, FV and PbO2, and a significant decrease in ICP (p < 0.05). Nine patients showed a decrease in lactate-pyruvate ratio at 60 minutes following HS infusion.
These results show that HS safely and effectively augments CBF in patients with poor grade SAH and significantly improves cerebral oxygenation. An improvement in cerebral metabolic status in terms of lactate-pyruvate ratio is also associated with HS infusion.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Hutchinson PJA, Seeley HM, Kirkpatrick PJ (1998) Factors implicated in deaths from subarachnoid haemorrhage: are they avoidable? Br J Neurosurg 12: 37–40
Kett-White R, Hutchinson PJ, Al-Rawi PG, Gupta AK, O’Connell MT, Pickard JD, Kirkpatrick PJ (2002) Extracellular lactate/pyruvate and glutamate changes in patients during peroperative episodes of cerebral ischaemia. Acta Neurochir (Wien) 81: 363–365
Kett-White R, Hutchinson PJ, Al-Rawi PG, Gupta AK, Pickard JD, Kirkpatrick PJ (2002) Adverse cerebral events detected after subarachnoid haemorrhage using brain oxygen and microdialysis probes. Neurosurgery 50: 1213–1222
Kett-White R, Hutchinson PJA, Al-Rawi PG, Czosnyka M, Gupta AK, Pickard JD, Kirkpatrick PJ (2002) Cerebral oxygen and microdialysis monitoring during aneurysm surgery: effects of blood pressure, csf drainage and temporary clipping on infarction. J Neurosurg 96: 1013–1019
Kiening KL, Unterberg AW, Bardt TF, Schneider G-H, Lanksch WR (1996) Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 85: 7–13
Kirkpatrick PJ, Smielewski P, Piechnik S, Pickard JD, Czosnyka M (1996) Early effects of mannitol in patients with head injuries assessed using bedside multimodality monitoring. Neurosurgery 39: 714–721
Persson L, Valtysson J, Enblad P, Wärme P-E, Cesarini K, Lewén A, Hillered L (1996) Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurg 74: 606–616
Qureshi AI, Wilson DA, Traystman RJ (2002) Treatment of transtentorial herniation unresponsive to hyperventilation using hypertonic saline in dogs: effect on cerebral blood flow and metabolism. J Neurosug Anaesthesiol 1: 22–30
Ross N, Hutchinson PJ, Seeley H, Kirkpatrick PJ (2002) Timing of surgery for supratentorial aneurysmal subarachnoid haemorrhage: report of a prospective study. J Neurol Neurosurg Psychiatry 72: 480–484
Sarrafzadeh AS, Kiening KL, Callsen T-A, Unterberg AW (2003) Metabolic changes during impending and manifest cerebral hypoxia in traumatic brain injury. Br J Neurosurg 17: 340–346
Sarrafzadeh AS, Sakowitz OW, Kiening KL, Benndorf G, Lanksch WR, Unterberg AW (2002) Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid haemorrhage patients? Crit Care Med 30: 1070
Sarrafzadeh AS, Haux D, Sakowitz O, Benndorf G, Herzog H, Kuechler I, Unterberg A (2003) Acute focal neurological deficits in aneurysmal subarachnoid haemorrhage. Relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis. Stroke 34: 1382–1388
Schultz MK, Wang LP, Tange M, et al (2000) Cerebral microdialysis monitoring: determination of normal and ischaemic cerebral metabolisms in patients with subarachnoid haemorrhage. J Neurosurg 93: 808–814
Schwarz S, Georgiadis D, Aschoff A, Schwab S (2002) Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke 33: 136–140
Shackford SR, Zhuang J, Schmoker J (1992) Intravenous fluid tonicity: effect on intracranial pressure, cerebral blood flow, and cerebral oxygen delivery in focal brain injury. J Neurosurg 76: 91–98
Suarez JI, Qureshi AI, Bhardwaj A, Williams MA, Schnitzer MS, Mirski M, Hanley DF, Ulatowski JA (1998) Treatment of refractory intracranial hypertension with 23.4% saline. Crit Care Med 26: 1118–1122
Tseng MY, Al-Rawi PG, Pickard JD, Rasulo FA, Kirkpatrick PJ (2003) Effect of hypertonic saline on cerebral blood flow in poor grade patients with subarachnoid haemorrhage. Stroke 34: 1389–1397
Yonas H, Sekhar L, Johnson DW, Gur D (1989) Determination of irreversible ischemia by xenon-enhanced computed tomographic monitoring of cerebral blood flow in patients with symptomatic vasospasm. Neurosurgery 24: 368–372
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag
About this paper
Cite this paper
Al-Rawi, P.G., Zygun, D., Tseng, M.Y., Hutchinson, P.J.A., Matta, B.F., Kirkpatrick, P.J. (2005). Cerebral blood flow augmentation in patients with severe subarachnoid haemorrhage. In: Poon, W.S., et al. Intracranial Pressure and Brain Monitoring XII. Acta Neurochirurgica Supplementum, vol 95. Springer, Vienna. https://doi.org/10.1007/3-211-32318-X_27
Download citation
DOI: https://doi.org/10.1007/3-211-32318-X_27
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-24336-7
Online ISBN: 978-3-211-32318-2
eBook Packages: MedicineMedicine (R0)