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Influence of hydroxylethyl starch infusions on cerebral blood flow in patients with severe traumatic brain injury

Introduction

The aim of the study was to evaluate the effects of hydroxylethyl starch (HES) solutions in patients with severe brain injury dependently of cerebral blood flow (CBF) type.

Methods

One hundred and twenty-six patients (female/male ratio, 32/94) with severe brain injury GCS < 8 were included. 76.2% patients passed surgery due to depressed skull fracture or intracerebral hemorrhage. CBF was assessed by transcranial Doppler ultrasonography (insonation of M1–2 segments of the middle cerebral artery (MCA) with assessment of linear blood velocity (LBV)). Patients were divided into three groups: I, with brain hyperemia (BH) (n = 42); II, with cerebral vasospasm (CVS) (n = 58); III, with brain hypoperfusion (BHP) (n = 26). All patients received volume replacement with 6% HES 200/0.5.

Results

Infusion of HES in group I causes a statistically significant increase of the cerebral blood volume, a rise of intracranial pressure (ICP) and central venous pressure (CVP) and leads to more deep depression of consciousness. In group II, HES provided some reduction of LBV in MCA and improvement of consciousness. Increasing CVP was statistically significant. In group III, increasing CVP and LBV in the MCA were observed. See Table 1.

Table 1 Table 1

Conclusion

Volume replacement with HES during severe traumatic brain injury gives best results in patients with CVS and BHP. HES in patients with BH is not expedient as it may increase ICP and CVP and lead to more deep depression of consciousness.

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Akmalov, A., Avakov, V. Influence of hydroxylethyl starch infusions on cerebral blood flow in patients with severe traumatic brain injury. Crit Care 12, P230 (2008). https://doi.org/10.1186/cc6451

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Keywords

  • Brain Injury
  • Cerebral Blood Flow
  • Middle Cerebral Artery
  • Central Venous Pressure
  • Intracerebral Hemorrhage