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Master Thesis

Caractérisation des facteurs associés à une augmentation de la pression tissulaire cérébrale en oxygène (ptio2) après un remplissage vasculaire chez le patient cérébrolésé

Abstract : Context: in patients with acute brain injury, upholding of cerebral blood flow (CBF) is essential to prevent cerebral ischemia. Brain tissue oxygen (PbtO2) monitoring is recommended in patients at risk. Intravascular volume expansion is used to increase PbtO2. The aim of our study was to explore predictors of an increase in PbtO2 after a volume expansion. Methods: we included patients admitted to ICU for acute brain injury, who were monitored with PbtO2 and for whom a volume expansion was performed to optimize cardiac output or CBF. Cardiac index (CI) was measured using transpulmonary thermodilution (TPTD) or transthoracic echocardiography (TTE). Hemodynamic and cerebral datasets were collected before and after the intervention. Intervention consisted in a volume expansion (500 mL crystalloids) volume expansion over 10 minutes. An increase of 10% or more in PbtO2 value following volume expansion was defined as significant. Results: 56 patients were included in the analysis. 49 (87.5%) were admitted for subarachnoid hemorrhage (SAH). 26 (46%) patients had a significant increase in PbtO2. In multivariable analysis, MAP variation following volume expansion was significantly associated with an increase in PbtO2 of more than 10% [OR = 1.68; 95% CI: 1.01 - 2.80; p=0.0464] unlike CI variation [OR=1.32; 95% CI: 0.90 - 1.93; p=0.1572]. Transcranial Doppler measurements did not show significant influence of middle cerebral artery blood flow velocity on the increase in PbtO2. Conclusion: a volume expansion increases PbtO2, mainly because of MAP increase and not because of cardiac output increase.
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https://dumas.ccsd.cnrs.fr/dumas-03113950
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Submitted on : Monday, January 18, 2021 - 4:37:13 PM
Last modification on : Tuesday, February 2, 2021 - 3:12:13 AM
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  • HAL Id : dumas-03113950, version 1

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Sébastien Munck. Caractérisation des facteurs associés à une augmentation de la pression tissulaire cérébrale en oxygène (ptio2) après un remplissage vasculaire chez le patient cérébrolésé. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03113950⟩

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