Clinical targeting of the cerebral oxygen cascade to improve brain oxygenation in patients with hypoxic-ischaemic brain injury after cardiac arrest.
Brain tissue oxygenation
Cardiac arrest
Cerebral blood flow
Cerebral oxygen delivery
Hypoxic–ischaemic brain injury
Neuromonitoring
Oxygen cascade
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
13
05
2023
accepted:
07
07
2023
medline:
14
9
2023
pubmed:
29
7
2023
entrez:
28
7
2023
Statut:
ppublish
Résumé
The cerebral oxygen cascade includes three key stages: (a) convective oxygen delivery representing the bulk flow of oxygen to the cerebral vascular bed; (b) diffusion of oxygen from the blood into brain tissue; and (c) cellular utilisation of oxygen for aerobic metabolism. All three stages may become dysfunctional after resuscitation from cardiac arrest and contribute to hypoxic-ischaemic brain injury (HIBI). Improving convective cerebral oxygen delivery by optimising cerebral blood flow has been widely investigated as a strategy to mitigate HIBI. However, clinical trials aimed at optimising convective oxygen delivery have yielded neutral results. Advances in the understanding of HIBI pathophysiology suggest that impairments in the stages of the oxygen cascade pertaining to oxygen diffusion and cellular utilisation of oxygen should also be considered in identifying therapeutic strategies for the clinical management of HIBI patients. Culprit mechanisms for these impairments may include a widening of the diffusion barrier due to peri-vascular oedema and mitochondrial dysfunction. An integrated approach encompassing both intra-parenchymal and non-invasive neuromonitoring techniques may aid in detecting pathophysiologic changes in the oxygen cascade and enable patient-specific management aimed at reducing the severity of HIBI.
Identifiants
pubmed: 37507572
doi: 10.1007/s00134-023-07165-x
pii: 10.1007/s00134-023-07165-x
pmc: PMC10499700
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1062-1078Informations de copyright
© 2023. The Author(s).
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