Acid-Base and Gas Tension Measurements in Cerebrospinal Fluid

Rossanda, M; Sganzerla, Erik P.

doi:10.1093/bja/48.8.753

Cited by 9 publications

(5 citation statements)

References 45 publications

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“…Our results from the control population regarding CSF electrolytes and acid-base variables are in line with the available literature [11,[27][28][29]: normal CSF has a pH around 7.35 with a SID close to 26 mmol/L. In CSF, the protein concentration is negligible, and electrical neutrality is guaranteed by a higher chloride concentration as compared with plasma (120 vs. 109 mmol/L).…”

Section: Discussionsupporting

confidence: 90%

“…Patients were enrolled between February 2017 and October 2018. Twenty spontaneously breathing patients with aneurismal SAH (aged 57 ± 11 years, 16 women, body mass index 25 [23][24][25][26][27][28][29]) were enrolled and studied on day 2 (2-4) after bleeding. The median World Federation Neurological Surgeons Scale score at ICU admission was 3.5 (1)(2)(3)(4), the median modified Fisher scale score was 4 (3-4), and the median Glasgow Coma Scale core on the study day was 12 (9)(10)(11)(12)(13)(14)(15).…”

Section: Description Of the Study Populationmentioning

confidence: 99%

“…On the contrary, meaningful differences between lumbar and ventricular CSF could be present in patients with SAH [29,42,43]. For this reason, we analyzed only ventricular CSF in patients with SAH because this is the extracellular fluid in close contact with the chemosensitive area [44][45][46].…”

Section: Limitationsmentioning

confidence: 99%

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Cerebrospinal Fluid and Arterial Acid–Base Equilibrium of Spontaneously Breathing Patients with Aneurismal Subarachnoid Hemorrhage

et al. 2022

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Background Hyperventilation resulting in hypocapnic alkalosis (HA) is frequently encountered in spontaneously breathing patients with acute cerebrovascular conditions. The underlying mechanisms of this respiratory response have not been fully elucidated. The present study describes, applying the physical–chemical approach, the acid-base characteristics of cerebrospinal fluid (CSF) and arterial plasma of spontaneously breathing patients with aneurismal subarachnoid hemorrhage (SAH) and compares these results with those of control patients. Moreover, it investigates the pathophysiologic mechanisms leading to HA in SAH. Methods Patients with SAH admitted to the neurological intensive care unit and patients (American Society of Anesthesiologists physical status of 1 and 2) undergoing elective surgery under spinal anesthesia were enrolled. CSF and arterial samples were collected simultaneously. Electrolytes, strong ion difference (SID), partial pressure of carbon dioxide (PCO2), weak noncarbonic acids (ATOT), and pH were measured in CSF and arterial blood samples. Results Twenty spontaneously breathing patients with SAH and 25 controls were enrolled. The CSF of patients with SAH, as compared with controls, was characterized by a lower SID (23.1 ± 2.3 vs. 26.5 ± 1.4 mmol/L, p < 0.001) and PCO2 (40 ± 4 vs. 46 ± 3 mm Hg, p < 0.001), whereas no differences in ATOT (1.2 ± 0.5 vs. 1.2 ± 0.2 mmol/L, p = 0.95) and pH (7.34 ± 0.06 vs. 7.35 ± 0.02, p = 0.69) were observed. The reduced CSF SID was mainly caused by a higher lactate concentration (3.3 ± 1.3 vs. 1.4 ± 0.2 mmol/L, p < 0.001). A linear association (r = 0.71, p < 0.001) was found between CSF SID and arterial PCO2. A higher proportion of patients with SAH were characterized by arterial HA, as compared with controls (40 vs. 4%, p = 0.003). A reduced CSF-to-plasma difference in PCO2 was observed in nonhyperventilating patients with SAH (0.4 ± 3.8 vs. 7.8 ± 3.7 mm Hg, p < 0.001). Conclusions Patients with SAH have a reduction of CSF SID due to an increased lactate concentration. The resulting localized acidifying effect is compensated by CSF hypocapnia, yielding normal CSF pH values and resulting in a higher incidence of arterial HA.

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Section: Discussionsupporting

confidence: 90%

Section: Description Of the Study Populationmentioning

confidence: 99%

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Cerebrospinal Fluid and Arterial Acid–Base Equilibrium of Spontaneously Breathing Patients with Aneurismal Subarachnoid Hemorrhage

et al. 2022

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“…It is known, however, that the concentrations of CSF constituents differ depending on the region from which they were collected. 44 Moreover, the concentrations of CSF constituents are different in the perivascular space and the subarachnoid space. 52 Another pitfall in previous experiments is directly related to the measurement of oxyhemoglobin in the CSF, because deoxyhemoglobin in the CSF is converted to oxyhemoglobin 14 by exposure to the oxygen in the fluid, 44 as well as by exposure of the CSF samples to air.…”

Section: Microdialysis Systemmentioning

confidence: 99%

“…Deoxyhemoglobin. This hemoglobin has received scant attention in delayed cerebral vasospasm, 54 perhaps because investigational samples are usually collected from the CSF, in which oxygen tension is high (31-47 mm Hg) 12,44 and in which at least 75% of deoxyhemoglobin is converted to oxyhemoglobin. 12 Exposure of test samples to oxygen levels that are higher than those within the clot could falsely produce the impression that oxyhemoglobin, and not deoxyhemoglobin, is present in the CSF samples.…”

Section: Microdialysis Systemmentioning

confidence: 99%