The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index.
Diffusion limited oxygen delivery following head injury*
Abstract
OBJECTIVE: To use a range of techniques to explore diffusion limitation as a mechanism of cellular hypoxia in the setting of head injury. DESIGN: A prospective interventional study. SETTING: A specialist neurocritical care unit. PATIENTS: Thirteen patients within 7 days of closed head injury underwent imaging studies. Tissue for ultrastructural studies was obtained from a cohort of seven patients who required surgery. INTERVENTIONS: Cerebral tissue PO2 (PtO2) was obtained using a multiple-variable sensor, and images of oxygen extraction fraction (OEF), derived from positron emission tomography, were used to calculate cerebral venous PO2 (PvO2). These data were used to derive the PvO2-PtO2 gradient in a region of interest around the sensor, which provided a measure of the efficiency of microvascular oxygen delivery. Measurements were repeated after PaCO2 was reduced from 37 +/- 3 to 29 +/- 3 torr (4.9 +/- 0.4 to 3.9 +/- 0.4 kPa) to assess the ability of the microvasculature to increase oxygen unloading during hypocapnia-induced hypoperfusion. Pericontusional tissue was submitted to electron microscopy to illustrate the structural correlates of physiologic findings. MEASUREMENTS AND MAIN RESULTS: Tissue regions with hypoxic levels of PtO2 (<10 torr) had similar levels of PvO2 compared with nonhypoxic areas and hence displayed larger PvO2-PtO2 gradients (27 +/- 2 vs. 9 +/- 8 torr, p <.001). Despite similar cerebral blood flow reductions with hyperventilation, hypoxic regions achieved significantly smaller OEF increases compared with normoxic regions (7 +/- 5 vs. 16 +/- 6 %, p <.05). Pericontusional tissue showed varying degrees of endothelial swelling, microvascular collapse, and perivascular edema. CONCLUSIONS: Increased diffusion barriers may reduce cellular oxygen delivery following head injury and attenuate the ability of the brain to increase oxygen extraction in response to hypoperfusion. Global or regional OEF underestimates tissue hypoxia due to such mechanisms.
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Cites
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A new classification of head injury based on computerized tomography
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Cited by
Deakin, C. D., Nolan, J. P., Soar, J., Sunde, K., Koster, R. W., Smith, G. B., & Perkins, G. D. (2010) · Resuscitation · doi:10.1016/j.resuscitation.2010.08.017 · Cited by 2,700
Nolan, J. P., Soar, J., Cariou, A., Cronberg, T., Moulaert, V. R. M., Deakin, C. D., Bottiger, B. W., Friberg, H., Sunde, K., & Sandroni, C. (2015) · Resuscitation · doi:10.1016/j.resuscitation.2015.07.018 · Cited by 1,116
European Resuscitation Council Guidelines for Resuscitation 2005
Nolan, J. P., Deakin, C. D., Soar, J., Böttiger, B. W., & Smith, G. (2005) · Resuscitation · doi:10.1016/j.resuscitation.2005.10.009 · Cited by 834
European Resuscitation Council Guidelines for Resuscitation 2005
Soar, J., Deakin, C. D., Nolan, J. P., Abbas, G., Alfonzo, A., Handley, A. J., Lockey, D., Perkins, G. D., & Thies, K. (2005) · Resuscitation · doi:10.1016/j.resuscitation.2005.10.004 · Cited by 832
Recent advances in traumatic brain injury
Khellaf, A., Khan, D. Z., & Helmy, A. (2019) · Journal of Neurology · doi:10.1007/s00415-019-09541-4 · Cited by 485
Metadata
- Authors
- Menon, D. K., Coles, J. P., Gupta, A. K., Fryer, T. D., Smielewski, P., Chatfield, D. A., Aigbirhio, F., Skepper, J. N., Minhas, P. S., Hutchinson, P. J., Carpenter, T. A., Clark, J. C., & Pickard, J. D.
- Venue
- Critical Care Medicine
- Published
- 2004-06
- Volume
- 32
- Issue
- 6
- Pages
- 1384-1390
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2128712943
- Cited by
- 340
- References
- 34
- FWCI
- 9.28
- Type
- journal article
- Language
- en
- Open access
- closed
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- Menon, D. K., Coles, J. P., Gupta, A. K., Fryer, T. D., Smielewski, P., Chatfield, D. A., Aigbirhio, F., Skepper, J. N., Minhas, P. S., Hutchinson, P. J., Carpenter, T. A., Clark, J. C., & Pickard, J. D. (2004). Diffusion limited oxygen delivery following head injury*. Critical Care Medicine. https://doi.org/10.1097/01.ccm.0000127777.16609.08
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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