Endotoxemia reduces cerebral perfusion but enhances dynamic cerebrovascular autoregulation at reduced arterial carbon dioxide tension

被引:24
作者
Brassard, Patrice [1 ]
Kim, Yu-Sok [2 ,3 ]
van Lieshout, Johannes [2 ,3 ,6 ]
Secher, Niels H. [4 ]
Rosenmeier, Jaya B. [5 ]
机构
[1] Univ Laval, Fac Med, Div Kinesiol, Dept Social & Prevent Med, Quebec City, PQ G1K 7P4, Canada
[2] Univ Amsterdam, Acad Med Ctr, Dept Internal Med, Heart Failure Res Ctr, NL-1105 AZ Amsterdam, Netherlands
[3] Univ Amsterdam, Acad Med Ctr, Lab Clin Cardiovasc Physiol, Heart Failure Res Ctr, NL-1105 AZ Amsterdam, Netherlands
[4] Univ Copenhagen, Rigshosp, Copenhagen Muscle Res Ctr, Dept Anesthesia, DK-2100 Copenhagen, Denmark
[5] Gentofte Univ Hosp, Dept Cardiol, Gentofte, Denmark
[6] Univ Nottingham, Sch Med, Sch Biomed Sci, Queens Med Ctr, Nottingham, England
关键词
autoregulation; carbon dioxide; cerebrovascular circulation; endotoxemia; OXIDE SYNTHASE INHIBITION; PASSIVE HEAT-STRESS; ORGAN BLOOD-FLOW; CARDIAC-OUTPUT; TRANSCRANIAL DOPPLER; SEPTIC SHOCK; SEPSIS; PRESSURE; REACTIVITY; VELOCITY;
D O I
10.1097/CCM.0b013e3182474ca7
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: The administration of endotoxin to healthy humans reduces cerebral blood flow but its influence on dynamic cerebral autoregulation remains unknown. We considered that a reduction in arterial carbon dioxide tension would attenuate cerebral perfusion and improve dynamic cerebral autoregulation in healthy subjects exposed to endotoxemia. Design: Prospective descriptive study. Setting: Hospital research laboratory. Subjects: Ten healthy young subjects (age: 32 +/- 8 yrs [mean +/- SD]; weight: 84 +/- 10 kg; weight: 184 +/- 5 cm; body mass index: 25 +/- 2 kg/m(2)) participated in the study. Interventions: Systemic hemodynamics, middle cerebral artery mean flow velocity, and dynamic cerebral autoregulation evaluated by transfer function analysis in the very low (<0.07 Hz), low (0.07-0.15 Hz), and high (>0.15 Hz) frequency ranges were monitored in these volunteers before and after an endotoxin bolus (2 ng/kg; Escherichia coli). Measurements and Main Results: Endotoxin increased body temperature of the subjects from 36.8 +/- 0.4 degrees C to 38.6 +/- 0.5 degrees C (p < .001) and plasma tumor necrosis factor-alpha from 5.6 (2.8-6.7) pg/mL to 392 (128-2258) pg/mL (p < .02). Endotoxemia had no influence on mean arterial pressure (95 [74-103] mm Hg vs. 92 [78-104] mm Hg; p = .75), but increased cardiac output (8.3 [6.1-9.5] L.min(-1) vs. 6.0 [4.5-8.2] L.min(-1); p = .02) through an elevation in heart rate (82 +/- 9 beats.min(-1) vs. 63 +/- 10 beats.min(-1); p < .001), whereas arterial carbon dioxide tension (37 +/- 5 mm Hg vs. 41 +/- 2 mm Hg; p < .05) and middle cerebral artery mean flow velocity (37 +/- 9 cm.sec(-1) vs. 47 +/- 10 cm.sec(-1); p < .01) were reduced. In regard to dynamic cerebral autoregulation, endotoxemia was associated with lower middle cerebral artery mean flow velocity variability (1.0 +/- 1.0 [cm.sec(-1)] Hz(-1) vs. 2.8 +/- 1.5 [cm.sec(-1)] Hz(-1); p < .001), reduced gain (0.52 +/- 0.11 cm.sec(-1).mm Hg-1 vs. 0.74 +/- 0.17 cm.sec(-1).mm Hg-1; p < .05), normalized gain (0.22 +/- 0.05 vs. 0.40 +/- 0.17%.%(-1); p < .05), and higher mean arterial pressure-to-middle cerebral artery mean flow velocity phase difference (p < .05) in the low frequency range (0.07-0.15 Hz). Conclusions: These data support that the reduction in arterial carbon dioxide tension explains the improved dynamic cerebral autoregulation and the reduced cerebral perfusion encountered in healthy subjects during endotoxemia. (Crit Care Med 2012; 40:1873-1878)
引用
收藏
页码:1873 / 1878
页数:6
相关论文
共 57 条
  • [1] CEREBRAL AUTO-REGULATION DYNAMICS IN HUMANS
    AASLID, R
    LINDEGAARD, KF
    SORTEBERG, W
    NORNES, H
    [J]. STROKE, 1989, 20 (01) : 45 - 52
  • [2] NON-INVASIVE TRANSCRANIAL DOPPLER ULTRASOUND RECORDING OF FLOW VELOCITY IN BASAL CEREBRAL-ARTERIES
    AASLID, R
    MARKWALDER, TM
    NORNES, H
    [J]. JOURNAL OF NEUROSURGERY, 1982, 57 (06) : 769 - 774
  • [3] Dynamic cerebral autoregulation and baroreflex sensitivity during modest and severe step changes in arterial PCO2
    Ainslie, Philip N.
    Celi, Leo
    McGrattan, Ken
    Peebles, Karen
    Ogoh, Shigehiko
    [J]. BRAIN RESEARCH, 2008, 1230 : 115 - 124
  • [4] Human Endotoxemia as a model of systemic inflammation
    Andreasen, A. S.
    Krabbe, K. S.
    Krogh-Madsen, R.
    Taudorf, S.
    Pedersen, B. K.
    Moller, K.
    [J]. CURRENT MEDICINAL CHEMISTRY, 2008, 15 (17) : 1697 - 1705
  • [5] Evaluation of a noninvasive transcranial Doppler and blood pressure-based method for the assessment of cerebral perfusion pressure in pregnant women
    Belfort, MA
    Tooke-Miller, C
    Varner, M
    Saade, G
    Grunewald, C
    Nisell, H
    Herd, JA
    [J]. HYPERTENSION IN PREGNANCY, 2000, 19 (03) : 331 - 340
  • [6] Sepsis and cytokines: Current status
    Blackwell, TS
    Christman, JW
    [J]. BRITISH JOURNAL OF ANAESTHESIA, 1996, 77 (01) : 110 - 117
  • [7] Non-invasive pulsatile arterial pressure and stroke volume changes from the human finger
    Bogert, LWJ
    van Lieshout, JJ
    [J]. EXPERIMENTAL PHYSIOLOGY, 2005, 90 (04) : 437 - 446
  • [8] THE NEUROLOGICAL COMPLICATIONS OF SEPSIS
    BOLTON, CF
    YOUNG, GB
    ZOCHODNE, DW
    [J]. ANNALS OF NEUROLOGY, 1993, 33 (01) : 94 - 100
  • [9] Cerebrovascular reactivity to carbon dioxide in sepsis syndrome
    Bowie, RA
    O'Connor, PJ
    Mahajan, RP
    [J]. ANAESTHESIA, 2003, 58 (03) : 261 - 265
  • [10] CEREBRAL BLOOD-FLOW IS REDUCED IN PATIENTS WITH SEPSIS SYNDROME
    BOWTON, DL
    BERTELS, NH
    PROUGH, DS
    STUMP, DA
    [J]. CRITICAL CARE MEDICINE, 1989, 17 (05) : 399 - 403