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(Stroke. 2000;31:1116.)
© 2000 American Heart Association, Inc.

Original Contributions

Effect of Short-Term Hyperventilation on Cerebral Blood Flow Autoregulation in Patients With Acute Bacterial Meningitis

Kirsten Møller, MD; Peter Skinhøj, MD, Professor, DrMedSci; Gitte Moos Knudsen, MD, Professor, DrMedSci Fin Stolze Larsen, MD, PhD, DrMedSci

From the Departments of Infectious Diseases (K.M., P.S.), Neurology (G.M.K.), and Hepatology (F.S.L.), University Hospital Rigshospitalet, Copenhagen, Denmark.

Correspondence to Dr Kirsten Møller, Department of Infectious Diseases, M7721, University Hospital Rigshospitalet, Tagensvej 20, DK-2200 Copenhagen N, Denmark. E-mail kirsten.moller{at}dadlnet.dk

Background and Purpose—Cerebral blood flow (CBF) autoregulation is impaired in patients with acute bacterial meningitis: this may be caused by cerebral arteriolar dilatation. We tested the hypothesis that CBF autoregulation is recovered by acute mechanical hyperventilation in 9 adult patients with acute bacterial meningitis.

Methods—Norepinephrine was infused to increase mean arterial pressure (MAP) 30 mm Hg from baseline. Relative changes in CBF were concomitantly recorded by transcranial Doppler ultrasonography of the middle cerebral artery, measuring mean flow velocity (V_mean), and by measurement of arterial to jugular oxygen content difference (a-v DO₂). The slope of the regression line between MAP and V_mean was calculated. Measurements were performed during normoventilation and repeated after 30 minutes of mechanical hyperventilation.

Results—At normoventilation (median PaCO₂ 4.4 kPa, range 3.5 to 4.9), MAP was increased from 68 mm Hg (60 to 101) to 109 mm Hg (95 to 126). V_mean increased with MAP from 48 cm/s (30 to 61) to 65 cm/s(33 to 86) (P<0.01), and a-v DO₂ decreased from 2.2 mmol/L (1.0 to 2.7) to 1.4 mmol/L (0.8 to 1.8) (P<0.05). During hyperventilation (PaCO₂ 3.5 kPa, range 3.3 to 4.1), MAP was increased from 76 mm Hg (58 to 92) to 109 mm Hg (95 to 121). V_mean increased from 45 cm/s (29 to 55) to 53 cm/s (33 to 78) (P<0.01), and a-v DO₂ decreased from 2.5 mmol/L (1.8 to 3.0) to 1.8 mmol/L (1.2 to 2.4) (P<0.05). Four patients recovered autoregulation completely during hyperventilation. The slope of the autoregulation curve decreased during hyperventilation compared with normoventilation (P<0.05).

Conclusions—CBF autoregulation is partially recovered during short-term mechanical hyperventilation in patients with acute bacterial meningitis, indicating that cerebral arteriolar dilation in part accounts for the regulatory impairment of CBF in these patients.

Key Words: autoregulation • cerebral blood flow • cerebral blood flow velocity • meningitis • ultrasonography, Doppler, transcranial

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