The State of Cerebral Perfusion-Metabolic Conjugation with Verticalization of Patients with Acute Subarachnoid Hemorrhage According to Cerebral Microdialysis
Gromov V.S., Belkin A. A, Levit A.L., Davydova N.S.
pp. 17-23
Regional Clinical Hospital №1, Yekatrrinburg, Russian Federation;
Ural State Medical University, Yekaterinburg, Russian Federation
DOI: 10.22138/2500-0918-2016-14-2-17-23
Abstract. One of the key strategies for the prevention of Post-Intensive Care Syndrome (PICS) in patients with acute cerebral insufficiency is overcoming bed-rest mode in the protocol of intensive therapy. The main risk of this procedure is the violation of perfusion-metabolic conjugation in the area of cerebral damage provoked by increased activity of neurons and simultaneously reduced perfusion due to violation of the mechanisms of autoregulation of cerebral blood flow. Adequately selected modality neuromonitoring allows you to control this process.
The aim of this study was to refine mechanisms of the Cerebral Injury Protection System response to passive verticalization in acute nontraumatic subarachnoid hemorrhage (SAH). Seven patients with angiospasm after SAH were included in the study. Under of multimodal monitoring (ICP, PICCO+, cerebral microdialysis, CT-perfusion, transcranial Doppler), patients underwent verticalization to 60–90 degrees on a tilt-table. At the upper points, we observed lowering ICP with a simultaneous increase in cerebral metabolism, which provoked the development of perfusion-metabolic imbalance in the metabolic penumbra area.
Conclusion. Verticalization has an activating effect on the functional state of the brain, which in conditions of the angiospasm-related failure of autoregulation of cerebral blood circulation can promote increasing areas of ischemia.
Keywords: verticalization, cerebral metabolism, perfusion-metabolic conjugation, cerebral microdialysis
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Authors:
Gromof Vladimir S.
Sverdlovsk Regional Hospital No.1
MD, PhD, physician. Critical care and Anesthesia Department
Russian Federation, Yekaterinburg, 620102, Volgogradskaya 185
vlgromov72@mail.ru
Levit Alexander L.
Sverdlovsk Regional Hospital No.1
MD, PhD, Professor of the Anesthesia and Reanimatology, Chief of the Critical Care and Anesthesia Department Russian Federation, Yekaterinburg, 620102, Volgogradskaya 185
Belkin Andrey A.
Ural State Medical University
MD, PhD, Professor of the Anesthesia and Reanimatology and Neurology Departments
Russian Federation, 623702, Sverdlovsk Region, Berezovsky str. Shilovsky, 28, Bldg. 6,
Davydova Nadegda S.
Ural State Medical University
MD, PhD, Full Professor, Chief of the Anesthesia and Reanimatology Department of the Ural State Medical University
Russian Federation, Yekaterinburg, Repin str.3
Received 25.04.2016
Gromov V.S., Belkin A.A., Levit A.L., Davydova N.S. The state of cerebral perfusion-metabolic conjugation with verticalization of patients with acute subarachnoid hemorrhage according to cerebral microdialysis [Sostoyanie cerebral’nogo perfuzionno-metabolicheskogo sopryazheniya pri vertikalizatsii patsientov s ostrym subarakhnoidal’nym krovoizliyzniem po dannym tserebtal’nogo mikrodializa] Vestnik uralskoi meditsinskoi akademicheskoi nauki – Vestn. Ural. Med. Akad. Nauki. 2016, no. 2, pp. 17–23. DOI: 10.22138/2500-0918-2016-14-2-17-23 [In Russ.]