Does splanchnic ischemia occur in isolated neurotrauma? A prospective observational study

Abstract

Splanchnic ischemia (intramucosal pH, <7.3) occurs commonly in isolated neurotrauma, with a statistically nonsignificant trend toward development of mucosal ischemia with decreased cerebral perfusion.

Trauma stimulates the synthesis of Gc-globulin

“…Gc-globulin belongs to a family of plasma proteins referred to as endotoxin-binding proteins [15]. Endotoxins may play a role in the pathophysiological events taking place after trauma, including isolated neurotrauma [16,17,18,19]. Recently Pape et al [20] demonstrated that patients who died after severe injury had a significantly lower production of antibodies against endotoxins, and that insufficient defence mechanisms towards endotoxin could lead to organ failure and death.…”

Splanchnic ischemia and gut permeability after acute brain injury secondary to intracranial hemorrhage

“…Several differences with Venkatesh's study can be identified [9]. First, the low pCO 2 gap threshold for ischemia (>8 mmHg) chosen by Venkatesh (as opposed to Miller [17] or Vallet [16]), might be overestimating the incidence of splanchnic ischemia.…”

“…Previous studies published by Venkatesh [9] and Takala [6], concluded that splanchnic ischemia appears to be common in head-injury or SAH patients. This is in direct contradiction with our results.…”

“…Very unusual high doses of norepinephrine were used by Venkatesh (1-20 lg/k/min) [9]. NE may induce splanchnic ischemia due to excessive vasocontriction at this range of dose.…”

“…Venkatesh et al, communicated an elevated incidence of splanchnic ischemia in patients with nonpenetrating craniocerebral trauma [9], an insult frequently associated with severe SIRS. Takala and cols., published similar findings in a group of patients with subarachnoid hemorrhage (SAH) after being subjected to general anesthesia for surgical or endovascular treatment of aneurisms [6].…”