TY - JOUR
T1 - The use of hyperventilation in the treatment of plateau waves in two patients with severe traumatic brain injury
T2 - Contrasting effects on cerebral oxygenation
AU - Imberti, Roberto
AU - Ciceri, Maria
AU - Bellinzona, Guido
AU - Pugliese, Raffaele
PY - 2000/4
Y1 - 2000/4
N2 - We present the case reports of two patients with severe traumatic brain injury who, in the absence of external stimuli, developed episodes of acute elevation of intracranial pressure (plateau waves) associated with jugular bulb oxyhemoglobin (SjO2) desaturation, severe reduction of cerebral tissue PO2 (PbrO2), and deterioration of neurological status. In all of these episodes hyperventilation was successful in extinguishing plateau waves, but in one patient it was associated with an improvement of both the global (increased SjO2) and local (increased PbrO2) cerebral perfusion, while in the other patient it was associated with a reduction of both SjO2 and PbrO2. In both patients the effects of hyperventilation (and other pharmacological treatments) were short-lived; plateau waves reappeared and the patients had to be submitted to decompressive craniotomy (first patient) and cerebrospinal fluid (CSF) drainage (second patient). We conclude that hyperventilation can be useful as a temporary measure to treat plateau waves, but cerebral oxygenation should always be monitored to avoid iatrogenic cerebral ischemia.
AB - We present the case reports of two patients with severe traumatic brain injury who, in the absence of external stimuli, developed episodes of acute elevation of intracranial pressure (plateau waves) associated with jugular bulb oxyhemoglobin (SjO2) desaturation, severe reduction of cerebral tissue PO2 (PbrO2), and deterioration of neurological status. In all of these episodes hyperventilation was successful in extinguishing plateau waves, but in one patient it was associated with an improvement of both the global (increased SjO2) and local (increased PbrO2) cerebral perfusion, while in the other patient it was associated with a reduction of both SjO2 and PbrO2. In both patients the effects of hyperventilation (and other pharmacological treatments) were short-lived; plateau waves reappeared and the patients had to be submitted to decompressive craniotomy (first patient) and cerebrospinal fluid (CSF) drainage (second patient). We conclude that hyperventilation can be useful as a temporary measure to treat plateau waves, but cerebral oxygenation should always be monitored to avoid iatrogenic cerebral ischemia.
KW - Brain injury
KW - Cerebral tissue oxygenation
KW - Hyperventilation
KW - Plateau waves
KW - SjO
UR - http://www.scopus.com/inward/record.url?scp=0034073099&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034073099&partnerID=8YFLogxK
U2 - 10.1097/00008506-200004000-00011
DO - 10.1097/00008506-200004000-00011
M3 - Article
C2 - 10774609
AN - SCOPUS:0034073099
VL - 12
SP - 124
EP - 127
JO - Journal of Neurosurgical Anesthesiology
JF - Journal of Neurosurgical Anesthesiology
SN - 0898-4921
IS - 2
ER -