Related Experiment Videos
Traumatic brain tissue acidosis: experimental and clinical studies
A Marmarou1, R Holdaway, J D Ward
1Division of Neurosurgery, Medical College of Virginia, Richmond.
Acta Neurochirurgica. Supplementum
|January 1, 1993
Summary
Severe head injury can cause brain tissue acidosis, prolonging coma. Tromethamine (THAM) treatment improved recovery in clinical trials, mitigating negative effects of hyperventilation and reducing intracranial pressure instability.
Area of Science:
- Neuroscience
- Biochemistry
- Trauma Research
Background:
- Severe head injury is associated with metabolic derangements, including brain tissue acidosis.
- Brain tissue acidosis may contribute to prolonged coma and neurological deficits after trauma.
- Tromethamine (THAM) is a potential therapeutic agent due to its buffering capacity and low toxicity.
Purpose of the Study:
- To investigate the efficacy of Tromethamine (THAM) in treating brain tissue acidosis following severe head injury.
- To evaluate the impact of THAM and hyperventilation on patient recovery and intracranial pressure (ICP) stability.
- To determine if THAM can buffer traumatized brain tissue and improve ICP stability in an animal model.
Main Methods:
- A clinical trial randomized patients with Glasgow Coma Scale (GCS) < 8 into control, THAM plus hyperventilation, or hyperventilation alone groups for 5 days.
- Glasgow Outcome Scale (GOS) was assessed at 3 and 6 months post-injury.
- Experimental studies used MR spectroscopy to measure brain lactate production and tissue pH in anesthetized cats subjected to fluid percussion injury, with randomization into control, THAM, and hyperventilation groups.
Main Results:
- Clinical trial analysis indicated that prophylactic hyperventilation alone retarded recovery.
- THAM treatment appeared to overcome the deleterious effects of hyperventilation, with reduced ICP instability observed in THAM-treated patients.
- Experimental studies showed increased brain lactate production post-trauma, which was not elevated in THAM-treated animals.
- Sustained hyperventilation was associated with the highest lactate production in injured animals.
Conclusions:
- THAM may be effective in buffering traumatized brain tissue and improving ICP stability.
- THAM treatment shows promise in mitigating the negative neurological outcomes associated with severe head injury and acidosis.
- Hyperventilation alone may be detrimental to recovery after severe head injury.