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Brain Oxygenation Response to Hypercapnia in Patients with Acute Brain Injury

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Abstract

Background

Cerebral hypoxia is a frequent cause of secondary brain damage in patients with acute brain injury. Although hypercapnia can increase intracranial pressure, it may have beneficial effects on tissue oxygenation. We aimed to assess the effects of hypercapnia on brain tissue oxygenation (PbtO2).

Methods

This single-center retrospective study (November 2014 to June 2022) included all patients admitted to the intensive care unit after acute brain injury who required multimodal monitoring, including PbtO2 monitoring, and who underwent induced moderate hypoventilation and hypercapnia according to the decision of the treating physician. Patients with imminent brain death were excluded. Responders to hypercapnia were defined as those with an increase of at least 20% in PbtO2 values when compared to their baseline levels.

Results

On a total of 163 eligible patients, we identified 23 (14%) patients who underwent moderate hypoventilation (arterial partial pressure of carbon dioxide [PaCO2] from 44 [42–45] to 50 [49–53] mm Hg; p < 0.001) during the study period at a median of 6 (4–10) days following intensive care unit admission; six patients had traumatic brain injury, and 17 had subarachnoid hemorrhage. A significant overall increase in median PbtO2 values from baseline (21 [19–26] to 24 [22–26] mm Hg; p = 0.02) was observed. Eight (35%) patients were considered as responders, with a median increase of 7 (from 4 to 11) mm Hg of PbtO2, whereas nonresponders showed no changes (from − 1 to 2 mm Hg of PbtO2). Because of the small sample size, no variable independently associated with PbtO2 response was identified. No correlation between changes in PaCO2 and in PbtO2 was observed.

Conclusions

In this study, a heterogeneous response of PbtO2 to induced hypercapnia was observed but without any deleterious elevations of intracranial pressure.

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Data Availability

Because of ethical restrictions, the data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request. All data generated after the analysis during this study are included in this published article and in its supplementary material.

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Authors and Affiliations

  1. Department of Intensive Care, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Route de Lennik, 808, Brussels, Belgium

    Marco Anderloni, Michele Salvagno, Lorenzo Peluso, Filippo Annoni, Fabio Silvio Taccone & Elisa Gouvea Bogossian

  2. Department of Intensive Care, Azienda Ospedaliera Univesitaria Integrata Di Verona, Verona, Italy

    Marco Anderloni & Katia Donadello

  3. Department of Neurosurgery, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

    Sophie Schuind

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Contributions

MA, EGB, and FST contributed to conception and design of the study. MA, MS, LP, and FA collected data. EGB and MA performed data curation. EGB, MA, and FST performed the statistical analysis. MA, EGB, and FST wrote the first draft of the manuscript. KD and SS revised the manuscript for intellectual content and English editing. All authors contributed to manuscript revision and read and approved the submitted version.

Corresponding author

Correspondence to Elisa Gouvea Bogossian.

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The study followed ethical guidelines, and the Erasme Hospital Ethics Committee approved this study (P2022/449). Written informed consent for study participation was waived by the ethics committee.

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Anderloni, M., Schuind, S., Salvagno, M. et al. Brain Oxygenation Response to Hypercapnia in Patients with Acute Brain Injury. Neurocrit Care 40, 750–758 (2024). https://doi.org/10.1007/s12028-023-01833-y

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