https://scholars.lib.ntu.edu.tw/handle/123456789/475981
標題: | Can cerebral hypoperfusion after sympathetic storm be used to diagnose brain death? A retrospective survey in traumatic brain injury patients | 作者: | Chai C.L. YONG-KWANG TU Huang S.-J. |
公開日期: | 2008 | 卷: | 64 | 期: | 3 | 起(迄)頁: | 688-697 | 來源出版物: | Journal of Trauma - Injury, Infection and Critical Care | 摘要: | BACKGROUND: The aim of this study was to identify the precise time of occurrence of irreversible coma from brain stem dysfunction that precedes brain death. Sympathetic storm, which is a cardiovascular hyperdynamic state manifested by brain stem ischemia, is known to be related to brain stem failure in animal models. We studied sympathetic storm in the clinical setting and compared the clinical findings observed before and after sympathetic storm to identify the precise time of occurrence of irreversible apneic coma. METHODS: We conducted a retrospective study of 15 comatose traumatic brain injury adult patients at the National Taiwan University Hospital's Neurosurgical Intensive Care Unit. Data on arterial blood pressure, heart rate, intracranial pressure, and clinical findings such as cerebral blood flow pattern, Glasgow Coma Scale, brain stem reflexes, utilizations of catecholamines, and occurrence of central diabetes insipidus throughout the course in the intensive care unit were collected retrospectively from medical records. RESULTS: Prolonged uncorrectable cerebral hypoperfusion was found after a characteristic irreversible apneic coma-associated sympathetic storm (IACASS) in all 15 patients. A mean cerebral perfusion pressure of 11.9 mm Hg ± 10.3 mm Hg and 13 mm Hg ± 3.5 mm Hg remained at 12 hours and 24 hours, respectively, after IACASS. Differences in clinical findings before and after IACASS that were statistically significant were cerebral circulation pattern (p = 0.0455), Glasgow Coma Scale (p = 0.0143), brain stem reflexes (p = 0.0143), utilization of catecholamines (p = 0.0254), and occurrence of central diabetes insipidus (p = 0.00468). CONCLUSIONS: Coma might have become irreversible immediately after IACASS because the prolonged duration of cerebral hypoperfusion could have caused irreversible cerebral tissue injury. Our study provides some preliminary findings suggesting that IACASS may be a predictor of impending brain death. A prospective study is the next step to understanding whether this phenomenon can be applied clinically to diagnose irreversible apneic coma. ? 2008 Lippincott Williams & Wilkins, Inc. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-40549089860&doi=10.1097%2fTA.0b013e31815ede12&partnerID=40&md5=6cc4c6b63a9bfc1a80dbcf0a8c05fad0 https://scholars.lib.ntu.edu.tw/handle/123456789/475981 |
ISSN: | 0022-5282 | DOI: | 10.1097/TA.0b013e31815ede12 | SDG/關鍵字: | dopamine; noradrenalin; adult; arterial pressure; article; artificial ventilation; brain death; brain hemorrhage; brain perfusion; brain stem; clinical article; coma; controlled study; craniotomy; diabetes insipidus; diagnostic procedure; disease association; female; health survey; heart rate; human; intensive care unit; intracranial pressure; male; priority journal; retrospective study; subarachnoid hemorrhage; subdural hematoma; sympathetic tone; time of death; traumatic brain injury; Adolescent; Adult; Analysis of Variance; Brain Death; Brain Injuries; Brain Ischemia; Cerebrovascular Circulation; Female; Glasgow Coma Scale; Humans; Male; Middle Aged; Monitoring, Physiologic; Retrospective Studies; Sympathetic Nervous System |
顯示於: | 醫學系 |
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