Abstract

Introduction: Splanchnic ischemia (SI) and increased gut permeability (GP) have been described in acute brain injury (ABI), although their incidence and relation to the type and severity of injury are uncertain. The aim of this study was to evaluate the incidence of both abnormalities in a series of patients with severe ABI secondary to intracranial hemorrhage (ICH) managed with a resuscitation protocol pursuing adequate cerebral and systemic hemodynamics. Methods: Eight patients with severe ABI secondary to ICH were admitted to the ICU and were mechanically ventilated and monitored with intracranial pressure measurement, jugular bulb venous oxygen saturation, arterial lactate concentration and gastric tonometry. All patients were managed actively to maintain adequate blood and cerebral perfusion pressures with a protocol based on agressive fluid resuscitation prior to vasoactive drugs administration. GP was assessed using the lactulose/mannitol test (LMT). Values were recorded during the first 7 days of hospital stay. Results: Arterial lactate concentration was within the normal range (1.9 ± 0.5 mmol/l) in all patients. Upon admission, the mean pCO2 gap was 8.2 ± 4.3 mmHg (1.09 ± 0.57 kPa) with an intramucosal pH of 7.4 ± 0.1. All patients had an abnormal LMT (0.066 ± 0.055) compared with 19 healthy volunteers (0.025 ± 0.004) (p < 0.05, Mann Whitney test). Conclusion: Splanchnic ischemia is uncommon among patients with acute brain injury secondary to intracranial hemorrhage, provided they are adequately resuscitated with a protocol based mainly on fluids to achieve an adequate CPP. Gut hyperpermeability is commonly present, despite the absence of splanchnic ischemia. © Humana Press Inc. 2007.