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Lewén, Anders
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Publications (10 of 34) Show all publications
Lewén, A., Dyhrfort, P., Clausen, F., Enblad, P. & Hillered, L. (2018). A Dedicated 21-Plex Pea Panel For High-Sensitive Protein Biomarker Detection Using Micro-Dialysis In Traumatic Brain Injury. Paper presented at 3rd Joint Symposium of the International-and-National-Neurotrauma-Societies-and-AANS/CNS-Section on Neurotrauma and Critical Care, AUG 11-16, 2018, Toronto, CANADA. Journal of Neurotrauma, 35(16), A130-A130
Open this publication in new window or tab >>A Dedicated 21-Plex Pea Panel For High-Sensitive Protein Biomarker Detection Using Micro-Dialysis In Traumatic Brain Injury
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2018 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 35, no 16, p. A130-A130Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
MARY ANN LIEBERT, INC, 2018
Keywords
Biomarker, Inflammation / Immune Function, Monitoring, Neurocritical Care
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-363876 (URN)000441527400353 ()
Conference
3rd Joint Symposium of the International-and-National-Neurotrauma-Societies-and-AANS/CNS-Section on Neurotrauma and Critical Care, AUG 11-16, 2018, Toronto, CANADA
Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2018-11-12Bibliographically approved
Svedung Wettervik, T., Lenell, S., Nyholm, L., Howells, T., Lewén, A. & Enblad, P. (2018). Decompressive craniectomy in traumatic brain injury: usage and clinical outcome in a single centre. Acta Neurochirurgica, 160(2), 229-237
Open this publication in new window or tab >>Decompressive craniectomy in traumatic brain injury: usage and clinical outcome in a single centre
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2018 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 160, no 2, p. 229-237Article in journal (Refereed) Published
Abstract [en]

Background: Two randomised controlled trials (RCTs) of decompressive craniectomy (DC) in traumatic brain injury (TBI) have shown poor outcome, but there are considerations of how these protocols relate to real practice. The aims of this study were to evaluate usage and outcome of DC and thiopental in a single centre.

Method: The study included all TBI patients treated at the neurointensive care unit, Akademiska sjukhuset, Uppsala, Sweden, between 2008 and 2014. Of 609 patients aged 16 years or older, 35 treated with DC and 23 treated with thiopental only were studied in particular. Background variables, intracranial pressure (ICP) measures and global outcome were analysed.

Results: Of 35 DC patients, 9 were treated stepwise with thiopental before DC, 9 were treated stepwise with no thiopental before DC and 17 were treated primarily with DC. Six patients received thiopental after DC. For 23 patients, no DC was needed after thiopental. Eighty-eight percent of our DC patients would have qualified for the DECRA study and 38% for the Rescue-ICP trial. Favourable outcome was 44% in patients treated with thiopental before DC, 56% in patients treated with DC without prior thiopental, 29% in patients treated primarily with DC and 52% in patients treated with thiopental with no DC.

Conclusions: The place for DC in TBI management must be evaluated better, and we believe it is important that future RCTs should have clearer and less permissive ICP criteria regarding when thiopental should be followed by DC and DC followed by thiopental.

Place, publisher, year, edition, pages
SPRINGER WIEN, 2018
Keywords
Traumatic brain injury, Neurointensive care, Standardised treatment protocol, Decompressive craniectomy, Thiopental
National Category
Neurology Surgery
Identifiers
urn:nbn:se:uu:diva-341558 (URN)10.1007/s00701-017-3418-3 (DOI)000419961200003 ()29234973 (PubMedID)
Available from: 2018-02-13 Created: 2018-02-13 Last updated: 2018-08-24Bibliographically approved
Borota, L., Mahmoud, E., Nyberg, C., Lewén, A., Enblad, P. & Ronne-Engström, E. (2018). Dual lumen balloon catheter - An effective substitute for two single lumen catheters in treatment of vascular targets with challenging anatomy. Journal of clinical neuroscience, 51, 91-99, Article ID S0967-5868(17)31621-1.
Open this publication in new window or tab >>Dual lumen balloon catheter - An effective substitute for two single lumen catheters in treatment of vascular targets with challenging anatomy
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2018 (English)In: Journal of clinical neuroscience, ISSN 0967-5868, E-ISSN 1532-2653, Vol. 51, p. 91-99, article id S0967-5868(17)31621-1Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe our experience in the treatment of various pathological conditions of the cranial and spinal blood vessels and hypervascularized lesions using dual lumen balloon catheters. Twenty-five patients were treated with endovascular techniques: two with vasospasm of cerebral blood vessels caused by subarachnoid hemorrhage, one with a hypervascularized metastasis in the vertebral body, two with spinal dural fistula, four with cerebral dural fistula, three with cerebral arteriovenous malformations, and 13 with aneurysms. The dual lumen balloon catheters were used for remodeling of the coil mesh, injection of various liquid embolic agents, particles and nimodipine, for the prevention of reflux and deployment of coils and stents. The diameter of catheterized blood vessels varied from 0.7 mm to 4 mm. Two complications occurred: perforation of an aneurysm in one case and gluing of the tip of balloon catheter by embolic material in another case. All other interventions were uneventful, and therapeutic goals were achieved in all cases except in the case with gluing of the tip of balloon catheter. The balloons effectively prevented reflux regardless of the type of the embolic material and diameter of blood vessel. The results of our study show that dual lumen balloon catheters allow complex interventions in the narrow cerebral and spinal blood vessels where the safe use of two single lumen catheters is either limited or impossible.

Keywords
Balloon catheter, Dual lumen, Neurointervention
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-350827 (URN)10.1016/j.jocn.2018.01.070 (DOI)000431932300022 ()29483004 (PubMedID)
Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-08-10Bibliographically approved
Rostami, E., Engquist, H., Howells, T., Johnson, U., Ronne-Engström, E., Nilsson, P., . . . Enblad, P. (2018). Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage. Journal of Neurosurgery, 128(6), 1762-1770
Open this publication in new window or tab >>Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage
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2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 128, no 6, p. 1762-1770Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE Delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is one of the major contributors to poor outcome. It is crucial to be able to detect early signs of DCI to prevent its occurrence. The objective of this study was to determine if low cerebral blood flow (CBF) measurements and pathological microdialysis parameters measured at the bedside can be observed early in patients with SAH who later developed DCI. METHODS The authors included 30 patients with severe SAH. The CBF measurements were performed at Day 0-3 after disease onset, using bedside xenon-CT. Interstitial glucose, lactate, pyruvate, glycerol, and glutamate were measured using microdialysis. RESULTS Nine of 30 patients developed DCI. Patients with DCI showed significantly lower global and regional CBF, and lactate was significantly increased in these patients. A high lactate/pyruvate ratio was also detected in patients with DCI. CONCLUSIONS Early low CBF measurements and a high lactate and lactate/pyruvate ratio may be early warning signs of the risk of developing DCI. The clinical value of these findings needs to be confirmed in larger studies.

Keywords
CBF, CBF = cerebral blood flow, CPP = cerebral perfusion pressure, DCI, DCI = delayed cerebral ischemia, GCS, GCS-M = Glasgow Coma Scale, GCS-motor, GOSE = Glasgow Outcome Scale–Extended, ICP = intracranial pressure, L/P = lactate/pyruvate, MD = microdialysis, NIC = neurointensive care, ROI = region of interest, SAH, SAH = subarachnoid hemorrhage, Xe-CT = xenon-CT, cerebral blood flow, delayed cerebral ischemia, lactate, lactate/pyruvate ratio, subarachnoid hemorrhage, vascular disorders, vasospasm, xenon-CT
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-330940 (URN)10.3171/2016.11.JNS161140 (DOI)000440653000023 ()28574309 (PubMedID)
Available from: 2017-10-07 Created: 2017-10-07 Last updated: 2018-10-12Bibliographically approved
Engquist, H., Rostami, E., Ronne-Engström, E., Nilsson, P., Lewén, A. & Enblad, P. (2018). Effect of HHH-Therapy on Regional CBF after Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT. Neurocritical Care, 28(2), 143-151
Open this publication in new window or tab >>Effect of HHH-Therapy on Regional CBF after Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT
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2018 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 28, no 2, p. 143-151Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Management of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is difficult and still carries controversies. In this study, the effect of therapeutic hypervolemia, hemodilution, and hypertension (HHH-therapy) on cerebral blood flow (CBF) was assessed by xenon-enhanced computerized tomography (XeCT) hypothesizing an increase in CBF in poorly perfused regions.

METHODS:

Bedside XeCT measurements of regional CBF in mechanically ventilated SAH patients were routinely scheduled for day 0-3, 4-7, and 8-12. At clinical suspicion of DCI, patients received 5-day HHH-therapy. For inclusion, XeCT was required at 0-48 h before start of HHH (baseline) and during therapy. Data from corresponding time-windows were also collected for non-DCI patients.

RESULTS:

Twenty patients who later developed DCI were included, and twenty-eight patients without DCI were identified for comparison. During HHH, there was a slight nonsignificant increase in systolic blood pressure (SBP) and a significant reduction in hematocrit. Median global cortical CBF for the DCI group increased from 29.5 (IQR 24.6-33.9) to 38.4 (IQR 27.0-41.2) ml/100 g/min (P = 0.001). There was a concomitant increase in regional CBF of the worst vascular territories, and the proportion of area with blood flow below 20 ml/100 g/min was significantly reduced. Non-DCI patients showed higher CBF at baseline, and no significant change over time.

CONCLUSIONS:

HHH-therapy appeared to increase global and regional CBF in DCI patients. The increase in SBP was small, while the decrease in hematocrit was more pronounced, which may suggest that intravascular volume status and rheological effects are of importance. XeCT may be potentially helpful in managing poor-grade SAH patients.

Keywords
Cerebral blood flow (CBF), Delayed cerebral ischemia (DCI), HHH-therapy (Triple-H), Subarachnoid hemorrhage (SAH), Xenon CT (XeCT)
National Category
Anesthesiology and Intensive Care Neurosciences
Identifiers
urn:nbn:se:uu:diva-330938 (URN)10.1007/s12028-017-0439-y (DOI)000431994700001 ()28983856 (PubMedID)
Available from: 2017-10-07 Created: 2017-10-07 Last updated: 2018-06-29Bibliographically approved
Engquist, H., Lewén, A., Howells, T., Johnson, U., Ronne-Engström, E., Nilsson, P., . . . Rostami, E. (2018). Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT.. Journal of Neurosurgical Anesthesiology, 30(1), 49-58
Open this publication in new window or tab >>Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT.
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2018 (English)In: Journal of Neurosurgical Anesthesiology, ISSN 0898-4921, E-ISSN 1537-1921, Vol. 30, no 1, p. 49-58Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome.

MATERIALS AND METHODS: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3.

RESULTS: Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBF<20 mL/100 g/min was detected in more than 10% of the region-of-interest (ROI) area and in 17 patients such low-flow area exceeded 30%. rCBF was not related to the localization of the aneurysm; there was no difference in rCBF of ipsilateral compared with contralateral vascular territories. In patients who initially were in Hunt & Hess grade I to III, median global CBF day 0 to 3 was significantly lower for patients who were in poor neurological state at discharge compared with patients in good neurological state, 25.5 mL/100 g/min (IQR, 21.3 to 28.3) versus 37.8 mL/100 g/min (IQR, 30.5 to 47.6).

CONCLUSIONS: CBF disturbances are common in the early phase after SAH. In many patients, CBF was heterogenic and substantial areas with low rCBF were detected. Age and CT Fisher grade were factors influencing global cortical CBF. Bedside XeCT may be a tool to identify patients at risk of deteriorating so they can receive intensified management, but this needs further exploration.

National Category
Anesthesiology and Intensive Care Neurosciences
Identifiers
urn:nbn:se:uu:diva-312080 (URN)10.1097/ANA.0000000000000395 (DOI)000428161600009 ()27906765 (PubMedID)
Available from: 2017-01-04 Created: 2017-01-04 Last updated: 2018-07-18Bibliographically approved
Abu Hamdeh, S., Marklund, N., Lewén, A., Howells, T., Raininko, R., Wikström, J. & Enblad, P. (2018). Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures.. Journal of Neurosurgery, 1-8
Open this publication in new window or tab >>Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures.
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2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, p. 1-8Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE Increased intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) with diffuse axonal injury (DAI) is not well defined. This study investigated the occurrence of increased ICP and whether clinical factors and lesion localization on MRI were associated with increased ICP in patients with DAI. METHODS Fifty-two patients with severe TBI (median age 24 years, range 9-61 years), who had undergone ICP monitoring and had DAI on MRI, as determined using T2*-weighted gradient echo, susceptibility-weighted imaging, and diffusion-weighted imaging (DWI) sequences, were enrolled. The proportion of good monitoring time (GMT) with ICP > 20 mm Hg during the first 120 hours postinjury was calculated and associations with clinical and MRI-related factors were evaluated using linear regression. RESULTS All patients had episodes of ICP > 20 mm Hg. The mean proportion of GMT with ICP > 20 mm Hg was 5%, and 27% of the patients (14/52) spent more than 5% of GMT with ICP > 20 mm Hg. The Glasgow Coma Scale motor score at admission (p = 0.04) and lesions on DWI sequences in the substantia nigra and mesencephalic tegmentum (SN-T, p = 0.001) were associated with the proportion of GMT with ICP > 20 mm Hg. In multivariable linear regression, lesions on DWI sequences in SN-T (8% of GMT with ICP > 20 mm Hg, 95% CI 3%-13%, p = 0.004) and young age (-0.2% of GMT with ICP > 20 mm Hg, 95% CI -0.07% to -0.3%, p = 0.002) were associated with increased ICP. CONCLUSIONS Increased ICP occurs in approximately one-third of patients with severe TBI who have DAI. Age and lesions on DWI sequences in the central mesencephalon (i.e., SN-T) are associated with elevated ICP. These findings suggest that MR lesion localization may aid prediction of increased ICP in patients with DAI.

Keywords
ADC = apparent diffusion coefficient, CPP = cerebral perfusion pressure, DAI = diffuse axonal injury, DWI = diffusion-weighted imaging, EVD = external ventricular drain, GCS = Glasgow Coma Scale, GMT = good monitoring time, GOSE = Glasgow Outcome Scale–Extended, ICC = intraclass correlation coefficient, ICP = intracranial pressure, MAP = mean arterial blood pressure, MRI, NICU = neurointensive care unit, SN-T = substantia nigra and mesencephalic tegmentum, SWI = susceptibility-weighted imaging, T2*GRE = T2*-weighted gradient echo, TBI, TBI = traumatic brain injury, diffuse axonal injury, diffusion-weighted imaging, elevated ICP, intracranial pressure, trauma, traumatic brain injury
National Category
Neurology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-362207 (URN)10.3171/2018.4.JNS18185 (DOI)30215559 (PubMedID)
Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-11-28Bibliographically approved
Johnson, U., Engquist, H., Lewén, A., Howells, T., Nilsson, P., Ronne-Engström, E., . . . Enblad, P. (2017). Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP. Acta Neurochirurgica, 159(6), 1065-1071
Open this publication in new window or tab >>Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP
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2017 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 159, no 6, p. 1065-1071Article in journal (Refereed) Published
Abstract [en]

Background Cerebral pressure autoregulation can be quantified with the pressure reactivity index (PRx), based on the correlation between blood pressure and intracranial pressure. Using PRx optimal cerebral perfusion pressure (CPPopt) can be calculated, i.e., the level of CPP where autoregulation functions best. The relation between cerebral blood flow (CBF) and CPPopt has not been examined. The objective was to assess to which extent CPPopt can be calculated in SAH patients and to investigate CPPopt in relation to CBF.

Methods Retrospective study of prospectively collected data. CBF was measured bedside with Xenon-enhanced CT (Xe-CT). The difference between actual CPP and CPPopt was calculated (CPPa dagger). Correlations between CPPa dagger and CBF parameters were calculated with Spearman's rank order correlation coefficient (rho). Separate calculations were done using all patients (day 0-14 after onset) as well as in two subgroups (day 0-3 and day 4-14).

Results Eighty-two patients with 145 Xe-CT scans were studied. Automated calculation of CPPopt was possible in adjunct to 60% of the Xe-CT scans. Actual CPP < CPPopt was associated with higher numbers of low-flow regions (CBF < 10 ml/100 g/min) in both the early phase (day 0-3, n = 39, Spearman's rho = -0.38, p = 0.02) and late acute phase of the disease (day 4-14, n = 35, Spearman's rho = -0.39, p = 0.02). CPP level per se was not associated with CBF.

Conclusions Calculation of CPPopt is possible in a majority of patients with severe SAH. Actual CPP below CPPopt is associated with low CBF.

Keywords
cerebral blood flow, autoregulation, CPP, subarachnoid haemorrhage
National Category
Clinical Medicine
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-294191 (URN)10.1007/s00701-017-3139-7 (DOI)000401117700016 ()28361248 (PubMedID)
Available from: 2016-09-21 Created: 2016-05-18 Last updated: 2017-06-13Bibliographically approved
Rostami, E., Engquist, H., Howells, T., Ronne-Engström, E., Nilsson, P., Hillered, L. T., . . . Enblad, P. (2017). The Correlation between Cerebral Blood Flow Measured by Bedside Xenon-CT and Brain Chemistry Monitored by Microdialysis in the Acute Phase following Subarachnoid Hemorrhage. Frontiers in Neurology, 8, Article ID 369.
Open this publication in new window or tab >>The Correlation between Cerebral Blood Flow Measured by Bedside Xenon-CT and Brain Chemistry Monitored by Microdialysis in the Acute Phase following Subarachnoid Hemorrhage
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2017 (English)In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 8, article id 369Article in journal (Refereed) Published
Abstract [en]

Cerebral microdialysis (MD) may be used in patients suffering from subarachnoid hemorrhage (SAH) to detect focal cerebral ischemia. The cerebral MD catheter is usually placed in the right frontal lobe and monitors the area surrounding the catheter. This generates the concern that a fall in cerebral blood flow (CBF) and ischemic events distant to the catheter may not be detected. We aimed to investigate if there is a difference in the association between the MD parameters and CBF measured around the MD catheter compared to global cortical CBF and to CBF in the vascular territories following SAH in the early acute phase. MD catheter was placed in the right frontal lobe of 30 SAH patients, and interstitial glucose, lactate, pyruvate, glycerol, and lactate/pyruvate ratio were measured hourly. CBF measurements were performed during day 0-3 after SAH. Global cortical CBF correlated strongly with CBF around the microdialysis catheter (CBF-MD) (r = 0.911, p ≤ 0.001). This was also the case for the anterior, middle, and posterior vascular territories in the right hemisphere. A significant negative correlation was seen between lactate and CBF-MD (r = -0.468, p = 0.009). The same relationship was observed between lactate and CBF in anterior vascular territory but not in the middle and posterior vascular territories. In conclusion, global CBF 0-3 days after severe SAH correlated strongly with CBF-MD. High lactate level was associated with low global CBF and low regional CBF in the right anterior vascular territory, when the MD catheter was placed in the right frontal lobe.

Keywords
Xenon-CT, cerebral blood flow, lactate, microdialysis, subarachnoid hemorrhage
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-330939 (URN)10.3389/fneur.2017.00369 (DOI)000407574600001 ()28824527 (PubMedID)
Available from: 2017-10-07 Created: 2017-10-07 Last updated: 2018-01-13Bibliographically approved
Nyholm, L., Howells, T., Lewén, A., Hillered, L. & Enblad, P. (2017). The influence of hyperthermia on intracranial pressure, cerebral oximetry and cerebral metabolism in traumatic brain injury. Upsala Journal of Medical Sciences, 122(3), 177-184
Open this publication in new window or tab >>The influence of hyperthermia on intracranial pressure, cerebral oximetry and cerebral metabolism in traumatic brain injury
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2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 3, p. 177-184Article in journal (Refereed) Published
Abstract [en]

Background: Hyperthermia is a common secondary insult in traumatic brain injury (TBI). The aim was to evaluate the relationship between hyperthermia and intracranial pressure (ICP), and if intracranial compliance and cerebral blood flow (CBF) pressure autoregulation affected that relationship. The relationships between hyperthermia and cerebral oximetry (B(ti)pO(2)) and cerebral metabolism were also studied. Methods: A computerized multimodality monitoring system was used for data collection at the neurointensive care unit. Demographic and monitoring data (temperature, ICP, blood pressure, microdialysis, B(ti)pO(2)) were analyzed from 87 consecutive TBI patients. ICP amplitude was used as measure of compliance, and CBF pressure autoregulation status was calculated using collected blood pressure and ICP values. Mixed models and comparison between groups were used. Results: The influence of hyperthermia on intracranial dynamics (ICP, brain energy metabolism, and B(ti)pO(2)) was small, but individual differences were seen. Linear mixed models showed that hyperthermia raises ICP slightly more when temperature increases in the groups with low compliance and impaired CBF pressure autoregulation. There was also a tendency (not statistically significant) for increased B(ti)pO(2), and for increased pyruvate and lactate, with higher temperature, while the lactate/pyruvate ratio and glucose were stable. Conclusions: The major finding was that the effects of hyperthermia on intracranial dynamics (ICP, brain energy metabolism, and B(ti)pO(2)) were not extensive in general, but there were exceptional cases. Hyperthermia treatment has many side effects, so it is desirable to identify cases in which hyperthermia is dangerous. Information from multimodality monitoring may be used to guide treatment in individual patients.

Keywords
Cerebral oximetry, hyperthermia, ICP, microdialysis, traumatic brain injury
National Category
Neurology Surgery
Identifiers
urn:nbn:se:uu:diva-340977 (URN)10.1080/03009734.2017.1319440 (DOI)000414107800004 ()28463046 (PubMedID)
Available from: 2018-02-05 Created: 2018-02-05 Last updated: 2018-02-05Bibliographically approved
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