Importance of hemodynamics management in patients with severe head injury and during hypothermia

Abstract

Objective. To evaluate the hemodynamics in patients with traumatic brain injury (TBI) during therapeutic hypothermia. Methods. Subjects were 25 patients with TBI (GCS; 8 or less). Mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), cardiac index (CI), systemic oxygen delivery (DO2), systemic vascular resistance index (SVRI), and pulmonary capillary wedge pressure (PCWP) were measured. Patients were retrospectively divided into 3 groups: normothermia (n = 5; NT), and survivors (n = 14; HT-S) and non-survivors (n = 6; HT-Non-S) after hypothermia, and hemodynamics were investigated for difference among groups at 24 hours from induction of normothermia or hypothermia. Results. CPP target was above 70 mmHg, however, HT-Non-S could not maintain CPP above 70 mmHg. The low CPP was the result of elevated ICP, low MAP (P < .05), or both during hypothermia. In HT-Non-S, significantly high SVRI and low CI (P < .05) causing dehydration were observed during cooling. D02 could not be maintained in HT-Non-S during hypothermia. Conclusions. These results suggest that patients run the risk of impairing hemodynamics during therapeutic hypothermia. Hemodynamic management is essential during hypothermia. If dehydration occurs during hypothermia, MAP may be reduced due to inadequate sedation, analgesia, and excess use of diuretic agents. © Springer-Verlag 2003.