Gustavo Cartaxo Patriota

Cerebral autoregulation represents one of the uncertain pathophysiological mechanisms in spontaneous intracerebral hemorrhage, whose impairment may influence the prognostic and therapeutic outcome. The objective of this work is to evaluate the dynamic cerebral autoregulation in a porcine model of spontaneous intracerebral hemorrhage through the cerebrovascular pressure reactivity index and to determine the effectiveness of clinical and surgical interventions. METHODS: Twenty-one 3-month-old male hybrid pigs were studied. The experimental model simulated the expansive effect of a large-volume spontaneous intracerebral hemorrhage when compared to the human brain. Different expansion volumes were evaluated, distributed into three groups with seven pigs each. The anesthetic protocol included invasive hemodynamic monitoring associated with preservation of cerebral autoregulation. The experiments were submitted to multimodal neurological monitoring and divided into 5 phases. The cerebrovascular pressure reactivity index estimated cerebral autoregulation during all phases, the first three without therapeutic interventions and the last two to assess the effectiveness of hypertonic saline interventions and surgery.

Thesis presented to the Faculty of Medicine of the University of São Paulo to obtain the title of Doctor of Science.