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Master Thesis

Impact de l'optimisation du débit cardiaque sur le débit sanguin cérébral chez le patient traumatisé crânien grave : étude "DébiTC"

Abstract : Maintaining cerebral blood flow (CBF) is fundamental after severe traumatic brain injury (TBI) to avoid secondary ischemic lesions. To optimize CBF after severe TBI, we hypothesized that an increase in cardiac output (CO) may increase CBF in these patients with frequent myocardial dysfunction. In 2013, a prospective randomized controlled study with cross over groups took place in order to raise CO by a positive inotropic, with constant mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and EtCO2 in patients with low CBF. After approval of ethics committee, patients were successively treated with norepinephrine and dobutamine, with randomized order allocation. CO was recorded continuously by transpulmonary thermodilution and echocardiography and CBF by a multimodal monitoring combining transcranial doppler (TCD) and cerebral oxygenation (PbO2). Four patients were included, with a mean age of 39 years, and a coma Glasgow score at 7. At baseline, mean velocity (TCD) was 43.8 cm/s, MAP was 80 mmHg and cardiac index (CI) was 3.7 L/min /m2. Increasing MAP at 95 mmHg by norepinephrine resulted in an increased in CBF (TCD mean velocity at 54.9 cm/s, for CI at 3.6 L/min/m2). At the same MAP, patients treated with dobutamine had a mean velocity (TCD) at 56.7 cm/s and CI was 5.3 L/min/m2. A correlation between CI, pulse pressure and pulsatility index (in TCD) seemed highlighted on these first results, however these findings need to be confirmed after inclusion of 20 patients as defined in the study protocol and then validated in a large multicenter cohort.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01218741
Contributor : Jean-Hugues Morneau <>
Submitted on : Wednesday, October 21, 2015 - 4:25:24 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:18 AM
Long-term archiving on: : Friday, April 28, 2017 - 6:22:28 AM

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  • HAL Id : dumas-01218741, version 1

Citation

Perrine Boucheix. Impact de l'optimisation du débit cardiaque sur le débit sanguin cérébral chez le patient traumatisé crânien grave : étude "DébiTC". Médecine humaine et pathologie. 2015. ⟨dumas-01218741⟩

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