Effect of two levels of induced hypocapnia on cerebral autoregulation in the acute phase of head injury coma.

Abstract

In eight unconscious and artificially ventilated patients with severe head injury, cerebral autoregulation (CA) was tested during angiotensin infusion, before and after a reduction of Paco2. Intracranial pressure (ICP) and systemic arterial pressure (SAP) were continuously recorded. Regional cerebral blood flow (rCBF) was measured by the intracarotid Xe133 washout technique as initial slope index, stochastic and compartmental analysis. In contradistinction to previous human studies, we found a preserved CA during moderate hypocapnia (mean Paco2 34.2 mmHg) while the CA after a further decrease in Paco2 (mean value 23.1 mmHg) was lost. The apparently preserved CA may be a "false phenomenon" due to a regional increase in ICP. After a decrease in Paco2, an association between high CO2 reactivity and rCBF increase during angiotensin was disclosed, while a decreased or unchanged rCBF was observed in regions with inverse steal or abolished CO2 reactivity. The study indicates that the interpretation of CA is facilitated by performing the test during two levels of Paco2, but the presence of impaired autoregulation in the acute phase of head injury indicates that deliberate increase in SAP may be dangerous, as it may provoke an increase of regional ICP and brain oedema.