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Effects of Hyperbaric Oxygenation Therapy on Cerebral Metabolism and Intracranial Pressure in Severely Brain Injured Pat

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Effects of Hyperbaric Oxygenation Therapy on Cerebral Metabolism and Intracranial Pressure in Severely Brain Injured Pat

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    1. Effects of Hyperbaric Oxygenation Therapy on Cerebral Metabolism and Intracranial Pressure in Severely Brain Injured Patients Rockswold SB et al. J Neurosurgery 94:403-411, March 2001 Presented by Ri ??? Supervisor Vs??? 91-8-11

    2. What is Hyperbaric Oxygen Therapy? entirely enclosed chamber breathing oxygen, greater than one atmosphere

    3. 1. Hyperoxygenation: a. Dissolves extra oxygen into the blood b. Angiogenesis in wound areas c. Sufficient oxygenation to ischemic tissues @ Useful in the treatment of anemias, ischemias and some poisonings

    4. 2. Mechanical effect of increased pressure: “Any free gas trapped in the body will decrease in volume as the pressure on it increases” @Successfully applied to air embolism and decompression sickness

    5. 3. Gas wash out effect The flooding of the body with any one gas tends to "wash out" all others. @Treatment for CO intoxication and cyanide poisoning

    6. 4. Vasoconstriction: Causes vasoconstriction without creating hypoxia which decreases edema decreases ICP @Useful in burns, crush injuries and interstitial bleeding @Acute brain and spinal cord injuries

    7. 5. Bacteriostasis: Inhibits growth of anaerobic as well as some aerobic organisms @Useful in conditions such as dysvascular conditions and disorders of immunosuppression

    8. Air or gas embolism CO poisoning Cyanide poisoning Crush injury and other acute traumatic ischemias Decompression sickness Enhancement of healing in selected problem wounds Exceptional blood loss anemia Selected refractory anaerobic infections Gas gangrene Necrotizing soft tissue infections Refractory osteomyelitis Radiation Necrosis Compromised Skin Grafts or Flaps Thermal Burns

    9. Oxygen Toxicity (cerebral and pulmonary toxicity) Cisplatinum, Doxorubicin COPD Pnumothorax History of seizures History of middle ear disorders/surgery Optic Neuritis Pregnancy High Fever URI; Viral infection Asthma Congenital Spherocytosis

    10. About the Study…

    11. Introduction: HBO therapy has been shown to reduce mortality by 50% in a prospective randomized trial of severely brain injured patients Objectives: Determine the effects of HBO on CBF, cerebral metabolism, and ICP, and to determine the optimal HBO treatment paradigm

    12. Materials and Methods: GCS 3-8, head injury N=37, 10 F, 27M, 1. Oxygen (100% O2, 1.5 ATA) was delivered to pts in hyperbaric chamber for 60 mins q24h 2. CBF, AVDO2, CMRO2, ventricular CSF lactate, and ICP values were obtained 1 hour before and 1 hour and 6 hours after a session

    13. Exclusion criterias: Unstable pulmonary status Pregnancy Unstable fracture <4 y/o Barbiturate-induced coma

    14. Patients were assigned to 3 categories: A) Reduced CBF before HBO B) Normal CBF before HBO (32.9-55.3ml/100g/min) C) Raised CBF before HBO

    15. Cerebral Blood Flow (CBF): nitrous oxide saturation method Cerebral Metabolism: 1. CMRO2=AVDO2 X CBF 2. CSF lactate level Intracranial Pressure (ICP): ventriculostomy with ICP monitor

    17. Group A, CBF was raised 1 hour and 6 hours after HBO (p < 0.05)

    18. Group B, CBF was increased at 1 hour (p < 0.05), but decreased by 6 hours after HBO

    19. Group C, CBF was reduced 1 hour and 6 hours after HBO (p < 0.05)

    20. In all patients AVDO2 remained constant both before and after HBO HBO may normalize the coupling of CBF and cerebral metabolism

    21. Group A, CMRO2 was raised 1 hour post-treatment

    22. Group B, CMRO2 was raised 1 hour post-treatment

    23. The CMRO2 was not affected when patients began with a raised CBF

    24. ICP higher than 15 mm Hg before HBO were decreased 1 hour and 6 hours after HBO (p < 0.05) Stimulation-induced increase in ICP

    25. The CSF lactate levels were consistently decreased 1 and 6 hours post-treatment, regardless of the pre-treatment CBF

    27. 1. The increased CMRO2 and decreased CSF lactate levels after treatment indicate that HBO may improve aerobic metabolism in severely brain injured patients

    28. 2. Elevated levels of ICP and CBF were reduced after HBO treatment HBO may promote BBB integrity, reduce cerebral edema and hyperemia, which in turns lower elevated ICP

    29. 3.The author asserts that shorter, more frequent sessions(30 min Q8H) in a pressurized chamber may optimize HBO treatment

    30. 4. This is the first study demonstrating that HBO therapy exerts a persistent effect on CBF and cerebral metabolism in severely injured patients

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