Martineau Joanie, Bernard Francis, Gagnon Alexandrine, Williams Virginie, Araujo de Franca Sabrina, Williamson David, Cavayas Yiorgos Alexandros
Division of Critical Care Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada.
Faculté de Médecine, Université de Montréal, Msontreal, Canada.
Crit Care Explor. 2025 Apr 2;7(4):e1241. doi: 10.1097/CCE.0000000000001241. eCollection 2025 Apr 1.
In critically ill patients with acute brain injury (ABI), maintaining intracranial pressure (ICP) and brain tissue oxygenation (PbtO2) within targets could prevent secondary neurologic injury. Tight control of CO2 (Paco2), a potent regulator of cerebrovascular tone, is generally advocated, but its vasomotor effect may be short-lived. Our aim was to compare the effect of the synchronous Paco2 vs. its variation from a previous baseline on PbtO2 and ICP.
We performed a post hoc analysis of a prospective cohort study collecting arterial blood gas (ABG) values alongside synchronous neuromonitoring variables. Linear mixed-effects models were fitted to evaluate the association between Paco2 and/or Paco2 variation from its average of the last 8-24 hr vs. PbtO2 and ICP, while controlling for cerebral perfusion pressure and Pao2.
Mixed medical-surgical ICU of Sacré-Coeur Hospital, an academic trauma center in Montreal, Canada.
All consecutive adult patients admitted for ABI with ICP and PbtO2 monitoring between May 2017 and November 2021.
None.
We included 78 patients with 3047 ABG-neuromonitoring couplets. The model using the variation of Paco2 from its average of the last 24 hr displayed the best performance for the prediction of PbtO2 (coefficient 0.37; 95% CI 0.21-0.53). The strongest predictor of ICP was the variation of Paco2 from its average of the last 8 hr (coefficient 0.17; 95% CI 0.10-0.23).
Variation in Paco2 from baseline is a more significant determinant of PbtO2 and ICP than the absolute Paco2 value at a given time. There may be a baseline vasomotor reset when patients are exposed to a given level of CO2 for 8 to 24 hr. Therefore, sustained intentional manipulation of Paco2 is unlikely to have lasting effects and slower correction rates of high or low Paco2 could help prevent brain tissue hypoxia or intracranial hypertension, respectively.
在急性脑损伤（ABI）的重症患者中，将颅内压（ICP）和脑组织氧合（PbtO2）维持在目标范围内可预防继发性神经损伤。通常主张严格控制二氧化碳（Paco2），它是脑血管张力的有效调节因子，但其血管运动效应可能是短暂的。我们的目的是比较同步Paco2与其相对于先前基线的变化对PbtO2和ICP的影响。
我们对一项前瞻性队列研究进行了事后分析，该研究收集动脉血气（ABG）值以及同步神经监测变量。拟合线性混合效应模型以评估Paco2和/或Paco2相对于其过去8 - 24小时平均值的变化与PbtO2和ICP之间的关联，同时控制脑灌注压和Pao2。
加拿大蒙特利尔的学术创伤中心圣心医院的内科 - 外科混合重症监护病房。
2017年5月至2021年11月期间所有因ABI入院并接受ICP和PbtO2监测的连续成年患者。
无。
我们纳入了78例患者，共3047对ABG - 神经监测数据。使用Paco2相对于其过去24小时平均值的变化的模型在预测PbtO2方面表现最佳（系数0.37；95%置信区间0.21 - 0.53）。ICP的最强预测因子是Paco2相对于其过去8小时平均值的变化（系数0.17；95%置信区间0.10 - 0.23）。
与给定时间的绝对Paco2值相比，Paco2相对于基线的变化是PbtO2和ICP更重要的决定因素。当患者暴露于给定水平的二氧化碳8至24小时时，可能会有基线血管运动重置。因此，持续有意操纵Paco2不太可能产生持久影响，而较高或较低Paco2的较慢校正率可能分别有助于预防脑组织缺氧或颅内高压。
