Cerebral effects of resuscitation with either epinephrine or vasopressin in an animal model of hemorrhagic shock

The Impact of Inotropes and Vasopressors on Cerebral Oxygenation in Patients with Traumatic Brain Injury and Subarachnoid Hemorrhage: A Narrative Review

Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are critical neurological conditions that necessitate specialized care in the Intensive Care Unit (ICU). Managing cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) is of primary importance in these patients. To maintain targeted MAP and CPP, vasopressors and/or inotropes are commonly used. However, their effects on cerebral oxygenation are not fully understood. The aim of this review is to provide an up-to date review regarding the current uses and pathophysiological issues related to the use of vasopressors and inotropes in TBI and SAH patients. According to our findings, despite achieving similar hemodynamic parameters and CPP, the effects of various vasopressors and inotropes on cerebral oxygenation, local CBF and metabolism are heterogeneous. Therefore, a more accurate understanding of the cerebral activity of these medications is crucial for optimizing patient management in the ICU setting.

The identification of blood pressure variation with hypovolemia based on the volume compensation method

Objective: The purpose of this study is to identify the blood pressure variation, which is important in continuous blood pressure monitoring, especially in the case of low blood volume, which is critical for survival. Methods: A pilot study was conducted to identify blood pressure variation with hypovolemia using five Landrace pigs. New multi-dimensional morphological features of Photoplethysmography (PPG) were proposed based on experimental study of hemorrhagic shock in pigs, which were strongly correlated with blood pressure changes. Five machine learning methods were compared to develop the blood pressure variation identification model. Results: Compared with the traditional blood pressure variation identification model with single characteristic based on single period area of PPG, the identification accuracy of mean blood pressure variation based on the proposed multi-feature random forest model in this paper was up to 90%, which was 17% higher than that of the traditional blood pressure variation identification model. Conclusion: By the proposed multi-dimensional features and the identification method, it is more accurate to detect the rapid variation in blood pressure and to adopt corresponding measures. Significance: Rapid and accurate identification of blood pressure variation under low blood volume ultimately has the potential to effectively avoid complications caused by abnormal blood pressure in patients with clinical bleeding trauma.

Effects of norepinephrine infusion on cerebral energy metabolism during experimental haemorrhagic shock

BACKGROUND

The use of norepinephrine in the case of life-threatening haemorrhagic shock is well established but widely discussed. The present study was designed to compare the effects of early norepinephrine treatment vs. no treatment on cerebral energy metabolism during haemorrhagic shock.

METHODS

Twelve pigs were subjected to haemorrhagic shock, 4 in the control group and 8 in the norepinephrine (NE) group. Following a 60 min baseline period haemorrhagic shock was achieved by bleeding all animals to a pre-defined mean arterial blood pressure (MAP) of approximately 40 mm Hg. When mean arterial pressure had decreased to 40 mmHg NE infusion started in the treatment group. After 90 min, NE infusion stopped, and all pigs were resuscitated with autologous blood and observed for 2.5 h. During the experiment cerebral tissue oxygenation (PbtO2) was monitored continuously and variables reflecting cerebral energy metabolism (glucose, lactate, pyruvate, glutamate, glycerol) were measured by utilizing intracerebral microdialysis.

RESULTS

All 12 pigs completed the protocol. NE infusion resulted in significantly higher MAP (p < 0.001). During the shock period lactate/pyruvate (LP) ratio group increased from 20 (15-29) to 66 (38-82) (median (IQR)) in the control group but remained within normal limits in the NE group. The significant increase in LP ratio in the control group remained after resuscitation. After induction of shock PbtO2 decreased markedly in the control group and was significantly lower than in the NE group during the resuscitation phase.

CONCLUSION

NE infusion during haemorrhagic shock improved cerebral energy metabolism compared with no treatment.