Anoxic brain injury pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
The underlying mechanism of post cardiac arrest syndrome is a combination of: <ref>Zeiner A, Holzer M, Sterz F, et al. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. Arch Intern Med. Sep 10 2001; 161(16): 2007-2012.</ref> <ref>van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. New England Journal of Medicine. Nov 8 2001;345(19): 1359-1367.</ref> <ref>Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. Feb 2003;31(2):359-366.</ref> <ref>Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862-871.</ref> <ref>Zandbergen EG, de Haan RJ, Stoutenbeek CP, et al. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet. Dec 5 1998; 352(9143): 1808-1812.</ref> <ref>Rello J. Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med. 1999;159:1742-1746.</ref> <ref>Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. New England Journal of Medicine. Jun 5 1997;336(23):1629-1633.</ref> <ref>Adrie C, Laurent I, Monchi M, et al. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care. Jun 2004;10(3):208-212.</ref> <ref>Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine. 2001;345(19):1368-1377.</ref> <ref>Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of hospital cardiac arrest with induced hypothermia. New England Journal of Medicine. Feb 21 2002;346(8):557-563.</ref> <ref>Hypothermia after Cardiac Arrest Study G. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. Erratum appears in N Engl J Med 2002 May 30;346(22):1756]. New England Journal of Medicine. Feb 21 2002;346(8):549-556.</ref> | The underlying mechanism of post [[cardiac arrest]] [[syndrome]] is a combination of: <ref>Zeiner A, Holzer M, Sterz F, et al. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. Arch Intern Med. Sep 10 2001; 161(16): 2007-2012.</ref> <ref>van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. New England Journal of Medicine. Nov 8 2001;345(19): 1359-1367.</ref> <ref>Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. Feb 2003;31(2):359-366.</ref> <ref>Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862-871.</ref> <ref>Zandbergen EG, de Haan RJ, Stoutenbeek CP, et al. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet. Dec 5 1998; 352(9143): 1808-1812.</ref> <ref>Rello J. Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med. 1999;159:1742-1746.</ref> <ref>Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. New England Journal of Medicine. Jun 5 1997;336(23):1629-1633.</ref> <ref>Adrie C, Laurent I, Monchi M, et al. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care. Jun 2004;10(3):208-212.</ref> <ref>Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine. 2001;345(19):1368-1377.</ref> <ref>Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of hospital cardiac arrest with induced hypothermia. New England Journal of Medicine. Feb 21 2002;346(8):557-563.</ref> <ref>Hypothermia after Cardiac Arrest Study G. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. Erratum appears in N Engl J Med 2002 May 30;346(22):1756]. New England Journal of Medicine. Feb 21 2002;346(8):549-556.</ref> | ||
===Systemic Response to Ischemia and Reperfusion=== | ===[[Systemic]] Response to [[Ischemia]] and [[Reperfusion]]=== | ||
:* Circulatory [[collapse]] | :* [[Circulatory]] [[collapse]] | ||
:* [[Hyperglycemia]] | :* [[Hyperglycemia]] | ||
:* [[Hypotension]] | :* [[Hypotension]] | ||
:* [[Infection]]s | :* [[Infection]]s | ||
:* Multiorgan failure | :* [[Multiorgan failure]] | ||
:* Ongoing tissue [[hypoxia]] / [[ischemia]] | :* Ongoing [[tissue]] [[hypoxia]] / [[ischemia]] | ||
:* [[Fever]] | :* [[Fever]] | ||
===Myocardial Dysfunction=== | ===Myocardial Dysfunction=== | ||
:* Circulatory [[collapse]] | :* [[Circulatory]] [[collapse]] | ||
:* [[Dysrhythmia]]s | :* [[Dysrhythmia]]s | ||
:* [[Hypotension]] | :* [[Hypotension]] | ||
:* Reduced [[cardiac output]] | :* Reduced [[cardiac output]] | ||
* | * ''[[Brain injury]]'' | ||
:* [[Brain death]] | :* [[Brain death]] | ||
:* Cognitive dysfunction | :* [[Cognitive]] [[dysfunction]] | ||
:* [[Coma]] | :* [[Coma]] | ||
:* Cortical [[stroke]] | :* [[cortical area|Cortical]] [[stroke]] | ||
:* [[Myoclonus]] | :* [[Myoclonus]] | ||
:* Persistent vegetative state | :* [[Persistent vegetative state]] | ||
:* Secondary [[parkinsonism]] | :* Secondary [[parkinsonism]] | ||
:* [[Seizure]]s | :* [[Seizure]]s | ||
:* Spinal [[stroke]] | :* [[Spinal]] [[stroke]] | ||
===Effects of Persistent Precipitating Pathologies=== | ===Effects of Persistent Precipitating Pathologies=== | ||
:* Cardiovascular disease ([[Acute coronary syndromes]], [[cardiomyopathy]]) | :* [[Cardiovascular]] disease ([[Acute coronary syndromes]], [[cardiomyopathy]]) | ||
:* [[Chronic obstructive pulmonary disease]] | :* [[Chronic obstructive pulmonary disease]] | ||
:* Central nervous system diseases (e.g. [[cerebrovascular accident]]) | :* [[Central nervous system]] diseases (e.g. [[cerebrovascular accident]]) | ||
:* Thromboembolic disorders (e.g. [[pulmonary emboli]]) | :* [[Thromboembolic]] disorders (e.g. [[pulmonary emboli]]) | ||
:* Drug / substance overdose, [[poisoning]] | :* [[drug overvdose|Drug /substance overdose]], [[poisoning]] | ||
:* [[Infection]]s ([[sepsis]], [[pneumonia]]) | :* [[Infection]]s ([[sepsis]], [[pneumonia]]) | ||
:* Volume loss ([[Hypovolemia]]: e.g. [[hemorrhage]], [[dehydration]]) | :* Volume loss ([[Hypovolemia]]: e.g. [[hemorrhage]], [[dehydration]]) |
Revision as of 14:54, 23 January 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Pathophysiology
The underlying mechanism of post cardiac arrest syndrome is a combination of: [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]
Systemic Response to Ischemia and Reperfusion
Myocardial Dysfunction
Effects of Persistent Precipitating Pathologies
- Cardiovascular disease (Acute coronary syndromes, cardiomyopathy)
- Chronic obstructive pulmonary disease
- Central nervous system diseases (e.g. cerebrovascular accident)
- Thromboembolic disorders (e.g. pulmonary emboli)
- Drug /substance overdose, poisoning
- Infections (sepsis, pneumonia)
- Volume loss (Hypovolemia: e.g. hemorrhage, dehydration)
References
- ↑ Zeiner A, Holzer M, Sterz F, et al. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. Arch Intern Med. Sep 10 2001; 161(16): 2007-2012.
- ↑ van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. New England Journal of Medicine. Nov 8 2001;345(19): 1359-1367.
- ↑ Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. Feb 2003;31(2):359-366.
- ↑ Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862-871.
- ↑ Zandbergen EG, de Haan RJ, Stoutenbeek CP, et al. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet. Dec 5 1998; 352(9143): 1808-1812.
- ↑ Rello J. Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med. 1999;159:1742-1746.
- ↑ Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. New England Journal of Medicine. Jun 5 1997;336(23):1629-1633.
- ↑ Adrie C, Laurent I, Monchi M, et al. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care. Jun 2004;10(3):208-212.
- ↑ Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine. 2001;345(19):1368-1377.
- ↑ Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of hospital cardiac arrest with induced hypothermia. New England Journal of Medicine. Feb 21 2002;346(8):557-563.
- ↑ Hypothermia after Cardiac Arrest Study G. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. Erratum appears in N Engl J Med 2002 May 30;346(22):1756]. New England Journal of Medicine. Feb 21 2002;346(8):549-556.