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Jan 27, 2023 · For that reason, it is critical to understand the clinical presentation, pathophysiology, and management options. This activity reviews the cause and presentation of hypoxic brain injury and highlights the role of the interprofessional team in its management. Objectives:
- Microcirculation and Reperfusion Injury
- Hemoglobin
- Carbon Dioxide
- Cerebral Edema
- Cerebral Autoregulation
- Temperature
- Normobaric Hyperoxia
After ROSC, microcirculatory perturbations lead to further neuron dysfunction. The cerebrovascular endothelium plays a critical role in maintaining blood-brain barrier integrity, regulation of microcirculatory blood flow, and release of autoanticoagulant mediators . Endothelial functions are compromised, and biomarkers of cerebrovascular endothelia...
Hemoglobin is a major determinant of arterial oxygen content. In animal studies of traumatic brain injury, concomitant anemia exacerbates secondary injury from apoptosis . However, physiologic benefits of improved CDO2 from transfusion must be balanced by risks associated with exogenous red blood cells. Although hemoglobin <70 g/L is the accepted t...
Partial pressure of arterial carbon dioxide (PaCO2) modulates cerebrovascular resistance and CBF via its effects on vascular smooth muscle . Specifically, hypocapnia (PaCO2 < 35 mmHg) induces cerebrovascular vasoconstriction and decreases CBF by about 2% to 3% for every 1 mmHg of PaCO2 . Clinically, hypocapnia reduces intracranial pressure (ICP) by...
After HIBI, cerebral edema is a recognized complication that causes secondary injury. Because of a fixed overall intracranial volume, an increase in the parenchymal bulk from cerebral edema in HIBI can cause intracranial hypertension with resultant decreases in cerebral perfusion pressure, CBF, and CDO2 . This vicious cycle of cerebral edema preci...
The brain has an innate ability to regulate blood flow to match metabolic demands. This phenomenon, termed cerebral autoregulation, allows the cerebrovasculature to undergo vasoconstriction and vasodilation over a range of mean arterial pressure (MAP) to maintain stable CBF . Cerebral autoregulation mitigates the effects of hypoperfusion (ischemia)...
Targeted temperature management has historically been the focus of considerable HIBI research. It is a mainstay in the management of HIBI by mitigating secondary injury after CA . At the cellular level, the beneficial effects of hypothermia are well documented. Cerebral metabolism is reduced by 5% to 10% per 1 °C decrease in core body temperature. ...
The dissolved portion of oxygen in plasma is a minor contributor to overall oxygen content. However, in disease states, this portion may have a pivotal role in ensuring adequate hemoglobin saturation for CDO2 and overcome diffusion barriers to restore normal cellular metabolism. Augmenting arterial oxygen content is touted as a crucial modifiable f...
- Mypinder S. Sekhon, Philip N. Ainslie, Donald E. Griesdale
- 2017
May 22, 2024 · Hypoxic-ischemic brain injury most often results from insults such as cardiac arrest, vascular catastrophe, poisoning (such as carbon monoxide intoxication or drug overdose), or head trauma. While many patients expire without recovering awareness, improved techniques in resuscitation and artificial life support have resulted in greater numbers ...
Feb 9, 2012 · The imaging findings depend on the aetiology of HIBI, the severity of the event (i.e. the circumstances and the effectiveness of resuscuitation), the relative component of ischaemia and hypoxia, the duration of the event, the underlying brain and the presence of co-morbidities.
- R. S. Howard, P. A. Holmes, A. Siddiqui, David Treacher, I. Tsiropoulos, M. Koutroumanidis
- 2012
This review describes the pathophysiological and molecular basis of hypoxic ischemic brain injury, and differentiates between the mechanisms of injury by cardiac arrest, pure respiratory arrest, and arrest secondary to cytotoxicity (e.g. carbon monoxide poisoning).
- Katharina M. Busl, David M. Greer
- 2010
Introduction. A hypoxic brain injury is a type of brain injury that occurs when there is a disruption in supply of oxygen to the brain. A diagnosis of hypoxic brain injury might not always be obvious, as the circumstances that caused the injury might not directly involve the brain, for example having a heart attack or inhaling smoke.
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What is the pathophysiological and molecular basis of hypoxic ischemic brain injury?
What is hypoxic ischaemic brain injury?
What is the long-term impact of hypoxic brain injury?
Abstract. Hypoxic–ischaemic brain injury is common and usually due to cardiac arrest or profound hypotension. The clinical pattern and outcome depend on the severity of the initial insult, the effectiveness of immediate resuscitation and transfer, and the post-resuscitation management on the intensive care unit.
