Efficacy of the cushing response in maintaining cerebral blood flow in premature and near-term fetal sheep

Pediatric Research
A P HarrisR C Koehler

Abstract

Fetal head compression during labor may increase intracranial pressure (ICP) and decrease cerebral perfusion pressure (CPP). An increase in mean arterial pressure (MAP) associated with the Cushing response normally acts to mitigate an ischemic insult when the increase in ICP approaches MAP. However, the premature fetus may be limited in its ability to increase MAP. We compared the efficacy of the pressor response in sustaining CPP, cerebral blood flow (CBF), and cerebral O2 consumption (CMRO2) in chronically catheterized fetal sheep at 0.6 gestation (92 d; n = 7) and 0.9 gestation (133 d; n = 7). When fetal ICP was increased to baseline MAP (41 +/- 3 mm Hg; +/-SEM) in 92-d fetuses, MAP increased by 7 +/- 2 mm Hg and remained stable during 30 min of constant ICP elevation; CBF decreased by 72% and CMRO2 decreased by 46%. In 133-d fetuses, MAP increased from 53 +/- 2 to 65 +/- 4 mm Hg at 3 min of elevated ICP; CBF decreased by 62% and CMRO2 decreased 30%. However, MAP continued to increase after 3 min and reached a stable level of 75 +/- 3 mmHg at 30 min in 133-d fetuses. The additional increase in MAP restored CBF and CMRO2 to baseline values. Plasma epinephrine and vasopressin concentrations increased between 6 and 33 min of el...Continue Reading

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Citations

Nov 5, 2019·NeoReviews·Michael D Weiss
Jul 13, 2001·American Journal of Physiology. Regulatory, Integrative and Comparative Physiology·A P HarrisR C Koehler
Jan 24, 2007·Anesthesia and Analgesia·Rebecca J McClaineJames D Reynolds
Jun 16, 2001·Journal of Applied Physiology·A P HarrisC A Gleason
Aug 31, 2016·The Biochemical Journal·A Mark EvansSandy Hartmann
Dec 24, 2005·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Irene RozetArthur M Lam
Dec 17, 2015·American Journal of Respiratory and Critical Care Medicine·Amira D MahmoudA Mark Evans
Feb 8, 2005·Seminars in Perinatology·Stephen A Back, Scott A Rivkees
Nov 22, 2021·American Journal of Obstetrics and Gynecology·Christopher A LearAlistair J Gunn

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