Az agyi perfúziós nyomás emelése dopaminnal--ellentmondásos hatások a súlyos koponyasérülés kezelésében.

Translated title of the contribution: Increasing cerebral perfusion pressure in serious cranial injury--contradictory effects of dopamine

P. Barzó, Andrea Czigner, Anthony Marmarou, Andrew Beaumont, Gábor Deák, Panos Fatouros, Frank Corwin

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Management of cerebral perfusion pressure is an important element of the treatment of traumatic brain injury. Vasopressors are accepted as a method of choice to increase mean arterial blood pressure and thus cerebral perfusion pressure in the face of rising intracranial pressure. There are, however, some unresolved issues and potential risks to this therapy. MATERIAL AND METHODS: This study therefore examines the effects of dopamine on physiological changes as well as on brain edema and water content that can be readily assessed by MRI/MRS in (1) a rodent model of rapidly rising intracranial pressure, caused by diffuse injury with secondary insult and (2) a model of cortical contusion. RESULTS: Dopamine was capable of restoring cerebral perfusion pressure in the model of rapidly rising intracranial pressure. However, this was associated with only a partial restoration of cerebral blood flow. In the brain tissue two profiles of change in the apparent diffusion coefficient of water (ADCw) were seen; one in which ADCw recovered to baseline, and one in which ADCw remained persistently low. Despite that dopamine did not alter these profiles, MRI-assessed tissue water content was increased four hours after injury and dopamine increased cerebral water content in both subgroups of injury, especially in the subgroup with a persistently low ADCw (p <0.01). In the contusion group dopamine significantly worsened the edema both in the injured and in the contralateral area of hippocampus and temporal cortex even though the ADCw values did not change, except for the contralateral hippocampus, where both water content and ADC, values rose with treatment, suggesting extracellular accumulation of water. CONCLUSION: The results suggest that dopamine has a double effect--while it temporarily and partially restores cerebral blood perfusion, at the same time it induces an increase in brain swelling and thus an increase in intracranial pressure in some cases. It is possible that in a subgroup of patients vasopressor treatment leads to an opposite effect several hours later. Vasopressor therapy in the clinical setting therefore should be cautiously applied.

Original languageHungarian
Pages (from-to)233-244
Number of pages12
JournalIdeggyógyászati szemle
Volume58
Issue number7-8
Publication statusPublished - Jul 20 2005

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Cerebrovascular Circulation
Dopamine
Water
Wounds and Injuries
Intracranial Pressure
Brain Edema
Hippocampus
Arterial Pressure
Intracranial Hypertension
Contusions
Temporal Lobe
Therapeutics
Rodentia
Edema

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Barzó, P., Czigner, A., Marmarou, A., Beaumont, A., Deák, G., Fatouros, P., & Corwin, F. (2005). Az agyi perfúziós nyomás emelése dopaminnal--ellentmondásos hatások a súlyos koponyasérülés kezelésében. Ideggyógyászati szemle, 58(7-8), 233-244.

Az agyi perfúziós nyomás emelése dopaminnal--ellentmondásos hatások a súlyos koponyasérülés kezelésében. / Barzó, P.; Czigner, Andrea; Marmarou, Anthony; Beaumont, Andrew; Deák, Gábor; Fatouros, Panos; Corwin, Frank.

In: Ideggyógyászati szemle, Vol. 58, No. 7-8, 20.07.2005, p. 233-244.

Research output: Contribution to journalArticle

Barzó, P, Czigner, A, Marmarou, A, Beaumont, A, Deák, G, Fatouros, P & Corwin, F 2005, 'Az agyi perfúziós nyomás emelése dopaminnal--ellentmondásos hatások a súlyos koponyasérülés kezelésében.', Ideggyógyászati szemle, vol. 58, no. 7-8, pp. 233-244.
Barzó, P. ; Czigner, Andrea ; Marmarou, Anthony ; Beaumont, Andrew ; Deák, Gábor ; Fatouros, Panos ; Corwin, Frank. / Az agyi perfúziós nyomás emelése dopaminnal--ellentmondásos hatások a súlyos koponyasérülés kezelésében. In: Ideggyógyászati szemle. 2005 ; Vol. 58, No. 7-8. pp. 233-244.
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abstract = "BACKGROUND: Management of cerebral perfusion pressure is an important element of the treatment of traumatic brain injury. Vasopressors are accepted as a method of choice to increase mean arterial blood pressure and thus cerebral perfusion pressure in the face of rising intracranial pressure. There are, however, some unresolved issues and potential risks to this therapy. MATERIAL AND METHODS: This study therefore examines the effects of dopamine on physiological changes as well as on brain edema and water content that can be readily assessed by MRI/MRS in (1) a rodent model of rapidly rising intracranial pressure, caused by diffuse injury with secondary insult and (2) a model of cortical contusion. RESULTS: Dopamine was capable of restoring cerebral perfusion pressure in the model of rapidly rising intracranial pressure. However, this was associated with only a partial restoration of cerebral blood flow. In the brain tissue two profiles of change in the apparent diffusion coefficient of water (ADCw) were seen; one in which ADCw recovered to baseline, and one in which ADCw remained persistently low. Despite that dopamine did not alter these profiles, MRI-assessed tissue water content was increased four hours after injury and dopamine increased cerebral water content in both subgroups of injury, especially in the subgroup with a persistently low ADCw (p <0.01). In the contusion group dopamine significantly worsened the edema both in the injured and in the contralateral area of hippocampus and temporal cortex even though the ADCw values did not change, except for the contralateral hippocampus, where both water content and ADC, values rose with treatment, suggesting extracellular accumulation of water. CONCLUSION: The results suggest that dopamine has a double effect--while it temporarily and partially restores cerebral blood perfusion, at the same time it induces an increase in brain swelling and thus an increase in intracranial pressure in some cases. It is possible that in a subgroup of patients vasopressor treatment leads to an opposite effect several hours later. Vasopressor therapy in the clinical setting therefore should be cautiously applied.",
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AU - Marmarou, Anthony

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AU - Fatouros, Panos

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N2 - BACKGROUND: Management of cerebral perfusion pressure is an important element of the treatment of traumatic brain injury. Vasopressors are accepted as a method of choice to increase mean arterial blood pressure and thus cerebral perfusion pressure in the face of rising intracranial pressure. There are, however, some unresolved issues and potential risks to this therapy. MATERIAL AND METHODS: This study therefore examines the effects of dopamine on physiological changes as well as on brain edema and water content that can be readily assessed by MRI/MRS in (1) a rodent model of rapidly rising intracranial pressure, caused by diffuse injury with secondary insult and (2) a model of cortical contusion. RESULTS: Dopamine was capable of restoring cerebral perfusion pressure in the model of rapidly rising intracranial pressure. However, this was associated with only a partial restoration of cerebral blood flow. In the brain tissue two profiles of change in the apparent diffusion coefficient of water (ADCw) were seen; one in which ADCw recovered to baseline, and one in which ADCw remained persistently low. Despite that dopamine did not alter these profiles, MRI-assessed tissue water content was increased four hours after injury and dopamine increased cerebral water content in both subgroups of injury, especially in the subgroup with a persistently low ADCw (p <0.01). In the contusion group dopamine significantly worsened the edema both in the injured and in the contralateral area of hippocampus and temporal cortex even though the ADCw values did not change, except for the contralateral hippocampus, where both water content and ADC, values rose with treatment, suggesting extracellular accumulation of water. CONCLUSION: The results suggest that dopamine has a double effect--while it temporarily and partially restores cerebral blood perfusion, at the same time it induces an increase in brain swelling and thus an increase in intracranial pressure in some cases. It is possible that in a subgroup of patients vasopressor treatment leads to an opposite effect several hours later. Vasopressor therapy in the clinical setting therefore should be cautiously applied.

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