Introduction

The consumption of energy by the brain is substantial (25 per cent of total glucose and 20 per cent of total oxygen consumed by the resting body). In contrast, the brain has negligible stores of oxygen and only a small content of energy-generating substrates. Therefore it is not surprising that the brain is uniquely susceptible to critical decreases in the delivery of substrate. As a result, monitoring the balance between the supply (cerebral blood flow, hemoglobin concentration, oxygen saturation, glucose concentration) and demand (cerebral metabolic rate for oxygen, cerebral metabolic rate for glucose) is of interest. Many therapeutic measures, such as control of intracranial pressure, modulation of systemic arterial pressure, and control of PaCO2, are undertaken in the belief that they may modify this balance beneficially. However, there is increasing evidence that so-called 'ischemic' brain injury may be due more to failure of the utilization of oxygen in a manner similar to that seen in association with the systemic inflammatory response syndrome rather than to failure of the delivery of oxygen per se.

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