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Alteration of cardiopulmonary function after severe head injury

Introduction

It is very hard to achieve optimal water balance in severe head injury (SHI) patients (Glasgow coma score ≤ 8). Cardiopulmonary complications are common after SHI: neurogenic pulmonary edema, cardiac failure, and so on [14]. In this study we present the alteration of cardiopulmonary function on pulse contour analysis calibrated by transpulmonary thermodilution (PiCCO-plus) monitoring after SHI.

Methods

Plasma catecholamines, natriuretic polypeptides, thrombomodulin and D-dimer of nine patients were measured immediately after SHI. The cardiopulmonary functions of nine consecutive patients were monitored by PiCCO-plus daily during a week after SHI.

Results

Noradrenalin, dopamine and brain natriuretic peptide concentrations were significantly high during the entire study period. Significantly higher elevations of plasma thrombomodulin and D-dimer concentrations were also observed after SHI. The intrathoracic blood volume was maintained in spite of systemic hypovolemia, and this fluid redistribution caused hydrostatic fluid retention in lung tissues on PiCCO-plus monitoring after SHI. See Figures 1 and 2.

Figure 1
figure1

Volume management of SHI patients on PiCCO-plus monitoring. CVP, central venous pressure; SVV, stroke volume variation; PPV, pulse pressure variation.

Figure 2
figure2

Lung water content of SHI patients on PiCCO-plus. ELWI, extravascular lung water index; PVPI, pulmonary vascular permeability index; EVLW, extravascular lung water; PBV, pulmonary vascular permeability index.

Conclusion

Persistent catecholamine release and the different sensitivity of blood vessels to catecholamine cause the blood volume redistribution: systemic hypovolemia and hydrostatic pulmonary edema. The excess cardiac preload due to catecholamine release leads to brain natriuretic peptide release resulting in natriuresis.

References

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Isotani, E., Otomo, Y. & Ohno, K. Alteration of cardiopulmonary function after severe head injury. Crit Care 13, P83 (2009). https://doi.org/10.1186/cc7247

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Keywords

  • Brain Natriuretic Peptide
  • Glasgow Coma Score
  • Severe Head Injury
  • Catecholamine Release
  • Transpulmonary Thermodilution