Cardiovascular response to severe head injury

The cardiovascular, pulmonary, and metabolic responses to severe head injury were studied clinically in the acute phase after severe head injury with the object of determining if a common response was present and, if so, its significance in the management of the patients' intracranial and systemic physiological states. Cardiac output, pulmonary capillary wedge pressure, arterial blood pressure, arterial and mixed venous blood gases, and arterial and mixed venous epinephrine (E) and norepinephrine (NE) levels were measured serially in 15 patients during the first 3 days after injury. A hyperdynamic state was found, characterized by increased cardiac output, cardiac work, moderate hypertension, tachycardia, decreased or normal systemic and pulmonary vascular resistance, increased pulmonary shunting, and increased oxygen delivery and utilization. Arterial E and NE levels correlated well with the cardiac output, cardiac work, blood pressure, heart rate, oxygen delivery, and oxygen utilization but not with vascular resistance or pulmonary shunt. The magnitude of the hyperdynamic state did not correlate with intracranial pressure, Glasgow Coma Scale score, or computerized tomography findings. It is concluded that a hyperdynamic cardiovascular state occurs after severe head injury, and that it is mediated in part by sympathetic nervous activity. The significance of this state for systemic management of patients with head injury is discussed.