Diffusion limited oxygen delivery following head injury

Critical Care Medicine
David K MenonJohn D Pickard

Abstract

To use a range of techniques to explore diffusion limitation as a mechanism of cellular hypoxia in the setting of head injury. A prospective interventional study. A specialist neurocritical care unit. Thirteen patients within 7 days of closed head injury underwent imaging studies. Tissue for ultrastructural studies was obtained from a cohort of seven patients who required surgery. Cerebral tissue PO2 (PtO2) was obtained using a multiple-variable sensor, and images of oxygen extraction fraction (OEF), derived from positron emission tomography, were used to calculate cerebral venous PO2 (PvO2). These data were used to derive the PvO2-PtO2 gradient in a region of interest around the sensor, which provided a measure of the efficiency of microvascular oxygen delivery. Measurements were repeated after PaCO2 was reduced from 37 +/- 3 to 29 +/- 3 torr (4.9 +/- 0.4 to 3.9 +/- 0.4 kPa) to assess the ability of the microvasculature to increase oxygen unloading during hypocapnia-induced hypoperfusion. Pericontusional tissue was submitted to electron microscopy to illustrate the structural correlates of physiologic findings. Tissue regions with hypoxic levels of PtO2 (<10 torr) had similar levels of PvO2 compared with nonhypoxic areas and h...Continue Reading

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Related Concepts

Teens
Brain
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Diffusion
Temporal Region Trauma
Dioxygen
Oxygen Consumption

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