BACKGROUND: In patients with neuronal injury, the knowledge of the status of cerebrovascular autoregulation can help to optimize the management of the cerebral perfusion pressure. This study characterizes dynamic and static cerebrovascular autoregulation during the first 7 days after severe traumatic brain injury or intracranial hemorrhage. METHODS: After approval from the IRB, 16 patients were studied. Cerebral blood flow velocity (CBFV) was measured daily for the assessment of dynamic (10 patients) and static (16 patients) cerebrovascular autoregulation in both the middle cerebral arteries using the transcranial Doppler sonography. Dynamic cerebrovascular autoregulation (dAR) was measured using the cuff-deflation method and was expressed by the index of the dAR. The index of the static cerebrovascular autoregulation (sAR) was calculated from changes in the CBFV in relation to drug-induced alterations of the arterial blood pressure. For statistical analyses, t test and mixed effect model were used. RESULTS: Both dAR and sAR after brain injury were impaired in most of the patients. The chronologic sequence of the dAR at the ipsilateral injured hemisphere showed a significant decrease until day 4 followed by an incomplete recovery (P < 0.002). Changes in sAR were similar, however, they did not gain statistical significance. CBFV was lower at day 1-2 after injury in comparison with day 4 to 7 (P < 0.02). CONCLUSION: Daily measured dAR and sAR were impaired after brain injury with a nadir on day 4 and consecutive incomplete recovery over time.
BACKGROUND: In patients with neuronal injury, the knowledge of the status of cerebrovascular autoregulation can help to optimize the management of the cerebral perfusion pressure. This study characterizes dynamic and static cerebrovascular autoregulation during the first 7 days after severe traumatic brain injury or intracranial hemorrhage. METHODS: After approval from the IRB, 16 patients were studied. Cerebral blood flow velocity (CBFV) was measured daily for the assessment of dynamic (10 patients) and static (16 patients) cerebrovascular autoregulation in both the middle cerebral arteries using the transcranial Doppler sonography. Dynamic cerebrovascular autoregulation (dAR) was measured using the cuff-deflation method and was expressed by the index of the dAR. The index of the static cerebrovascular autoregulation (sAR) was calculated from changes in the CBFV in relation to drug-induced alterations of the arterial blood pressure. For statistical analyses, t test and mixed effect model were used. RESULTS: Both dAR and sAR after brain injury were impaired in most of the patients. The chronologic sequence of the dAR at the ipsilateral injured hemisphere showed a significant decrease until day 4 followed by an incomplete recovery (P < 0.002). Changes in sAR were similar, however, they did not gain statistical significance. CBFV was lower at day 1-2 after injury in comparison with day 4 to 7 (P < 0.02). CONCLUSION: Daily measured dAR and sAR were impaired after brain injury with a nadir on day 4 and consecutive incomplete recovery over time.
Authors: Jennifer Frontera; Wendy Ziai; Kristine O'Phelan; Peter D Leroux; Peter J Kirkpatrick; Michael N Diringer; Jose I Suarez Journal: Neurocrit Care Date: 2015-06 Impact factor: 3.210
Authors: Baxter B Allen; Ya-Lin Chiu; Linda M Gerber; Jamshid Ghajar; Jeffrey P Greenfield Journal: Pediatr Crit Care Med Date: 2014-01 Impact factor: 3.624
Authors: Hadie Adams; Joseph Donnelly; Marek Czosnyka; Angelos G Kolias; Adel Helmy; David K Menon; Peter Smielewski; Peter J Hutchinson Journal: PLoS Med Date: 2017-07-25 Impact factor: 11.069
Authors: Patrick Schramm; Klaus Ulrich Klein; Lena Falkenberg; Manfred Berres; Dorothea Closhen; Konrad J Werhahn; Matthias David; Christian Werner; Kristin Engelhard Journal: Crit Care Date: 2012-10-04 Impact factor: 9.097