Cerebral hemometabolism: from isolated measurements to monitoring and therapy

Cruz, Julio

doi:10.1590/S0004-282X1993000100001

Abstracts

An overview is presented on historical and multivariate aspects of cerebral hemometabolism. This involves a full multivariate approach, from blood pressure to cerebral metabolism. From isolated measurements, to monitoring and management, a comprehensive overview of cerebral hemometabolism is addressed, from its inception to current days, up to a new concept, the cerebral hemodynamic reserve. A multivariate functional diagram is proposed, to summarize the multivariate interrelationships of cerebral hemometabolism. A generic proposition is mode for studies of truly normal cerebral hemometabolism in children, for subsequent clinical applications. Another proposition is made for multivariate cerebral hemometabolic monitoring, in a broad variety of circumstances of predominantly global changes in intracranial dynamics, both in animal and clinical research.

cerebral hemometabolism; physiologic monitoring; multivariate therapy

Neste trabalho é apresentado um apanhado sobre aspectos evolutivos (históricos; e multivariáveis do hemometabolismo cerebral. Isto envolve desde a pressão arterial até o metabolismo tecidual cerebral. De medidas isoladas, até monitorização e tratamento, tem-se uma abordagem compreensiva do hemometabolismo cerebral, desde seus primórdios até os dias atuais, culminando com um novo conceito, a reserva hemodinâmica cerebral. Um diagrama multivariável funcional é proposto, para sintetizar as interrelações multivariáveis do hemometabolismo cerebral. Uma proposição genérica é apresentada para que se estude o hemometabolismo cerebral verdadeiramente normal na infância, para subsequentes aplicações clínicas. Também é proposta vasta gama em potencial de aplicações em monitorização hemometabólica cerebral, além daquelas em trauma craniencefálico, para estados em que a dinâmica intracraniana esteja modificada de forma predominantemente difusa.

hemometabolismo cerebral; monitorização fisiológica; terapêutica multivariável

Hemometabolismo cerebral: de medidas isoladas a medidas de monitorização e terapêutica

Cerebral hemometabolism: from isolated measurements to monitoring and therapy

Julio Cruz

Disciplina de Neurocirurgia e Centro de Trauma Cranicefálico, Universidade da Pennsylvania, Philadelphia

RESUMO

Neste trabalho é apresentado um apanhado sobre aspectos evolutivos (históricos; e multivariáveis do hemometabolismo cerebral. Isto envolve desde a pressão arterial até o metabolismo tecidual cerebral. De medidas isoladas, até monitorização e tratamento, tem-se uma abordagem compreensiva do hemometabolismo cerebral, desde seus primórdios até os dias atuais, culminando com um novo conceito, a reserva hemodinâmica cerebral. Um diagrama multivariável funcional é proposto, para sintetizar as interrelações multivariáveis do hemometabolismo cerebral. Uma proposição genérica é apresentada para que se estude o hemometabolismo cerebral verdadeiramente normal na infância, para subsequentes aplicações clínicas. Também é proposta vasta gama em potencial de aplicações em monitorização hemometabólica cerebral, além daquelas em trauma craniencefálico, para estados em que a dinâmica intracraniana esteja modificada de forma predominantemente difusa.

Palavras-chave: hemometabolismo cerebral, monitorização fisiológica, terapêutica multivariável.

SUMMARY

An overview is presented on historical and multivariate aspects of cerebral hemometabolism. This involves a full multivariate approach, from blood pressure to cerebral metabolism. From isolated measurements, to monitoring and management, a comprehensive overview of cerebral hemometabolism is addressed, from its inception to current days, up to a new concept, the cerebral hemodynamic reserve. A multivariate functional diagram is proposed, to summarize the multivariate interrelationships of cerebral hemometabolism. A generic proposition is mode for studies of truly normal cerebral hemometabolism in children, for subsequent clinical applications. Another proposition is made for multivariate cerebral hemometabolic monitoring, in a broad variety of circumstances of predominantly global changes in intracranial dynamics, both in animal and clinical research.

Key words: cerebral hemometabolism, physiologic monitoring, multivariate therapy.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Agradecimento

O autor deve muito e agradece a seus progenitores, Julio Adamor Cruz (in memoriam) e Hermendina Xavier Cruz, por 25 anos de suporte integral e inestimável, durante o processo educacional; ao Rotary Clube de Pinheiros, São Paulo, SP, e à Rotary Foundation of Rotary International, pela Bolsa de Pós Graduação (1980-81) que lhe abriu amplamente as portas da profissionalização no exterior; e aos doutores Dario Birolini, Vittorio Rolando Bocoaletti (in memoriam), Aloysio de Mattos Pimenta (in memoriam), Orestes Barini, Flávio Aurelio Parente Settanni, Antonio de Pádua Furquim Bonnatelli, Fernando de Menezes Braga, Juan Oscar Alarcon Adorno, José Luiz Gomes do Amaral, Alberto Alain Gabbai, Raul Marino Jr., Oswaldo Ricciardi Cruz, João Teixeira Pinto, Virgilio Novaes, Thomas William Langfitt, Thomas Anthon Gennarelli, Wayne Maurice Alves, Michiael Erwin Miner e Eugene Sommer Flamm, por várias formas de incentivo, orientação e apoio nas carreiras de Neurocirurgia e de pesquisa.

Aceite: 02-julho-1992

Julio Cruz, M.D. Division of Neurosurgery, Hospital of the University of Pennsylvania 3400 Spruce St. Philadelphia, Pennsylvania 19104, USA.

1. Chan K-H, Dearden NM, Miller JD. The significance of posttraumatic increase in cerebral blood flow velocity: a transcranial doppler ultrasound study. Neurosurgery 1992, 30: 697-700.
2. Cruz J, Allen SJ, Miner ME. Hypoxic insults in acute brain injury. Crit Care Med 1985, 13:284 (abstr).
3. Cruz J, Miner ME. Modulating cerebral oxygen delivery and extraction in acute traumatic coma. In Miner ME, Wagner KA (eds): Neurotrauma: Treatment, Rehabilitation, and Related Issues. Boston: Butterworths, 1986, p 55-72.
4. Cruz J. Continuous versus serial global cerebral hemometabolic monitoring: applications in acute brain trauma. Acta Neurochir 1988, 42(Suppl): 35-39.
5. Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA. Continuous monitoring of cerebral oxygenation in acute brain injury: injection of mannitol during hyperventilation. J Neurosurg 1990, 73:725-730.
6. Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA. Continuous monitoring of cerebral oxygenation in acute brain injury: assessment of cerebral hemodynamic reserve. Neurosurgery 1991, 29:743-749.
7. Cruz J, Gennarelli TA, Alves WM. Continuous, monitoring of cerebral oxygenation in acute brain injury: multivariate assessment of severe intracranial «plateau» wave: case report. J Trauma 1992, 32:401-403.
8. Cruz J, Gennarelli TA, Alves WM. Continuous monitoring of cerebral hemodynamic reserve in acute brain injury: relationship to changes in brain swelling. J Trauma 1992, 32:629-635.
9. Cruz J, Alves WM, Gennarelli TA, Allen SJ, Miner ME. Cerebral aerobic index and oxygen/glucose ratio in acute brain injury. In Avezaat CJJ et al. (eds): Intracranial Pressure VIII. Berlin: Springer-Verlag (In press).
10. Cruz J, Gennarelli TA, Hoffstad OJ. Lack of relevance of the Bohr effect in optimally ventilated patients with acute brain trauma. J Trauma 1992, 33:304-311.
11. Garlick R, Bihari D. The use of intermittent and continuous recordings of jugular venous bulb oxygen saturation in the unconscious patient. Scand J Clin Lab Invest 1987, 47 (Suppl 188): 47-52.
12. Gibbs EL, Lennox WG, Nims LF, Gibbs FA. Arterial and cerebral venous blood: arterial-venous differences in man. J Biol Chem 1942, 144:325-332.
13. Guillaume J, Janny P. Manometrie intnacrânienne continue: intérêt de la méthode et premiers résultats. Rev Neurol 1951, 84:131-142.
14. Kennedy C, Sokoloff L. An adaptation of the nitrous oxide method to the study of the cerebral circulation in children: normal values for cerebral blood flow and cerebral metabolic rate in childhood J Clin Invest 1957, 36:1130-1137.
15. Kety SS, Schmidt CF. The nitrous oxide method for the quantitative determination of cerebral blood flow in man: theory, procedure, and normal values. J Clin Invest 1948, 27:476-483.
16. Lassen NA. The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis localized within the brain. Lancet 1966, 2:1113-1115.
17. Lenzi GL, Frackowiack RS, Jones T. Cerebral oxygen metabolism and blood flow in human cerebral ischemic infarction. J Cereb Blood Flow Metab 1982, 2:321-335.
18. Miller JD. Head injury and brain ischemia: implications for therapy. Br J Anesth 1985, 57:120-130.
19. Obrist WD, Thompson HK Jr, Wang HS, Wilkinson WE. Regional cerebral blood flow estimated by 133xenon inhalation. Stroke 1975, 6:245-256.
20. Settergren G, Lindblach BS, Persson B. Cerebral blood flow and exchange of oxygen, glucose, ketone bodies, lactate, pyruvate, and aminoacids in anesthetised children. Acta Pediatr Scand 1980, 69:457-465.
21. Sheinberg M, Kanter MJ, Robertson CS, Contant CF, Narayan RK, Grossman RG. Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg 1992, 76:212-217.
22. Ter-Pogossian MM, Eichling JO, Davis DO, Welch MJ, Metzger JM. The determination of regional cerebral blood flow by means of water labeled with radioactive oxygen 15. Radiology 1969, 93:31-40.
23. Ter-Pogossian MM, Eichiling JO, Davis DO, Welch MJ. The measure in vivo of regional cerebral oxygen utilization by means of oxyhemoglobin labeled with radioactive oxygen-15. J Clin Invest 1970, 49:381-391.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Mar 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Chan K-H, Dearden NM, Miller JD. The significance of posttraumatic increase in cerebral blood flow velocity: a transcranial doppler ultrasound study. Neurosurgery 1992, 30: 697-700.

[2] 2. Cruz J, Allen SJ, Miner ME. Hypoxic insults in acute brain injury. Crit Care Med 1985, 13:284 (abstr).

[3] 3. Cruz J, Miner ME. Modulating cerebral oxygen delivery and extraction in acute traumatic coma. In Miner ME, Wagner KA (eds): Neurotrauma: Treatment, Rehabilitation, and Related Issues. Boston: Butterworths, 1986, p 55-72.

[4] 4. Cruz J. Continuous versus serial global cerebral hemometabolic monitoring: applications in acute brain trauma. Acta Neurochir 1988, 42(Suppl): 35-39.

[5] 5. Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA. Continuous monitoring of cerebral oxygenation in acute brain injury: injection of mannitol during hyperventilation. J Neurosurg 1990, 73:725-730.

[6] 6. Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA. Continuous monitoring of cerebral oxygenation in acute brain injury: assessment of cerebral hemodynamic reserve. Neurosurgery 1991, 29:743-749.

[7] 7. Cruz J, Gennarelli TA, Alves WM. Continuous, monitoring of cerebral oxygenation in acute brain injury: multivariate assessment of severe intracranial «plateau» wave: case report. J Trauma 1992, 32:401-403.

[8] 8. Cruz J, Gennarelli TA, Alves WM. Continuous monitoring of cerebral hemodynamic reserve in acute brain injury: relationship to changes in brain swelling. J Trauma 1992, 32:629-635.

[9] 9. Cruz J, Alves WM, Gennarelli TA, Allen SJ, Miner ME. Cerebral aerobic index and oxygen/glucose ratio in acute brain injury. In Avezaat CJJ et al. (eds): Intracranial Pressure VIII. Berlin: Springer-Verlag (In press).

[10] 10. Cruz J, Gennarelli TA, Hoffstad OJ. Lack of relevance of the Bohr effect in optimally ventilated patients with acute brain trauma. J Trauma 1992, 33:304-311.

[11] 11. Garlick R, Bihari D. The use of intermittent and continuous recordings of jugular venous bulb oxygen saturation in the unconscious patient. Scand J Clin Lab Invest 1987, 47 (Suppl 188): 47-52.

[12] 12. Gibbs EL, Lennox WG, Nims LF, Gibbs FA. Arterial and cerebral venous blood: arterial-venous differences in man. J Biol Chem 1942, 144:325-332.

[13] 13. Guillaume J, Janny P. Manometrie intnacrânienne continue: intérêt de la méthode et premiers résultats. Rev Neurol 1951, 84:131-142.

[14] 14. Kennedy C, Sokoloff L. An adaptation of the nitrous oxide method to the study of the cerebral circulation in children: normal values for cerebral blood flow and cerebral metabolic rate in childhood J Clin Invest 1957, 36:1130-1137.

[15] 15. Kety SS, Schmidt CF. The nitrous oxide method for the quantitative determination of cerebral blood flow in man: theory, procedure, and normal values. J Clin Invest 1948, 27:476-483.

[16] 16. Lassen NA. The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis localized within the brain. Lancet 1966, 2:1113-1115.

[17] 17. Lenzi GL, Frackowiack RS, Jones T. Cerebral oxygen metabolism and blood flow in human cerebral ischemic infarction. J Cereb Blood Flow Metab 1982, 2:321-335.

[18] 18. Miller JD. Head injury and brain ischemia: implications for therapy. Br J Anesth 1985, 57:120-130.

[19] 19. Obrist WD, Thompson HK Jr, Wang HS, Wilkinson WE. Regional cerebral blood flow estimated by 133xenon inhalation. Stroke 1975, 6:245-256.

[20] 20. Settergren G, Lindblach BS, Persson B. Cerebral blood flow and exchange of oxygen, glucose, ketone bodies, lactate, pyruvate, and aminoacids in anesthetised children. Acta Pediatr Scand 1980, 69:457-465.

[21] 21. Sheinberg M, Kanter MJ, Robertson CS, Contant CF, Narayan RK, Grossman RG. Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg 1992, 76:212-217.

[22] 22. Ter-Pogossian MM, Eichling JO, Davis DO, Welch MJ, Metzger JM. The determination of regional cerebral blood flow by means of water labeled with radioactive oxygen 15. Radiology 1969, 93:31-40.

[23] 23. Ter-Pogossian MM, Eichiling JO, Davis DO, Welch MJ. The measure in vivo of regional cerebral oxygen utilization by means of oxyhemoglobin labeled with radioactive oxygen-15. J Clin Invest 1970, 49:381-391.

Brasil

Brasil

Cerebral hemometabolism: from isolated measurements to monitoring and therapy

Hemometabolismo cerebral: de medidas isoladas a medidas de monitorização e terapêutica

Abstracts

Publication Dates