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. 2010 Nov;115(4):221-31.
doi: 10.3109/03009734.2010.503906.

Metabolic effects of a late hypotensive insult combined with reduced intracranial compliance following traumatic brain injury in the rat

Konstantin Salci  1 , Per Enblad, Michel Goiny, Charles F Contant, Ian Piper, Pelle Nilsson
Affiliations

Metabolic effects of a late hypotensive insult combined with reduced intracranial compliance following traumatic brain injury in the rat

Konstantin Salci et al. Ups J Med Sci. 2010 Nov.

Abstract

Introduction: Traumatic brain injury makes the brain vulnerable to secondary insults. Post-traumatic alterations in intracranial dynamics, such as reduced intracranial compliance (IC), are thought to further potentiate the effects of secondary insults. Reduced IC combined with intracranial volume insults leads to metabolic disturbances in a rat model. The aim of the present study was to discern whether a post-traumatic hypotensive insult in combination with reduced IC caused more pronounced secondary metabolic disturbances in the injured rat brain.

Materials and methods: Rats were randomly assigned to four groups (n = 8/group): 1) trauma with hypotension; 2) trauma and reduced IC with hypotension; 3) sham injury with hypotension; and 4) sham injury and reduced IC with hypotension. A weight drop model of cortical contusion trauma was used. IC was reduced by gluing rubber film layers on the inside of bilateral bone flaps before replacement. Microdialysis probes were placed in the perimeter of the trauma zone. Hypotension was induced 2 h after trauma. Extracellular (EC) levels of lactate, pyruvate, hypoxanthine, and glycerol were analyzed.

Results: The trauma resulted in a significant increase in EC dialysate levels of lactate, lactate/pyruvate ratio, hypoxanthine, and glycerol. A slight secondary increase in lactate was noted for all groups but group 2 during hypotension, otherwise no late effects were seen. There were no effects of reduced IC.

Discussion: In conclusion, reduced IC did not increase the metabolic disturbances caused by the post-traumatic hypotensive insult. The results suggest that a mild to moderate hypotensive insult after initial post-traumatic resuscitation may be tolerated better than an early insult before resuscitation.

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Figures

Figure 1.
Figure 1.
Flow chart of the experiment. Time periods; T1 pre-impact, T2 post-impact, T3 pre-insult, T4 insult, and T5 reperfusion. MD = microdialysis.
Figure 2.
Figure 2.
Blood pressure during the time periods (mean ± SD of 30 time points/time period). For statistics and significance see Tables II and III. Time periods T1–T5. Sh0/3 and Tr0/3 = sham/trauma injury with 0/3 layers of rubber film.
Figure 3.
Figure 3.
ICP during the time periods (mean ± SD of 30 time points/time period). For statistics and significance see Tables II and III. Time periods T1–T5. Sh0/3 and Tr0/3 = sham/trauma injury with 0/3 layers of rubber film.
Figure 4.
Figure 4.
Lactate (A), L/P ratio (B), hypoxanthine (C), and glycerol (D) during the time periods (mean ± SD of 3 samples/time period). For statistics and significance see Tables II and III. T1–T5: time periods. Sh0/3 and Tr0/3 = sham/trauma injury with 0/3 layers of rubber film.
Figure 4.
Figure 4.
Lactate (A), L/P ratio (B), hypoxanthine (C), and glycerol (D) during the time periods (mean ± SD of 3 samples/time period). For statistics and significance see Tables II and III. T1–T5: time periods. Sh0/3 and Tr0/3 = sham/trauma injury with 0/3 layers of rubber film.
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