Jatinder S Minhas1, Ronney B Panerai1,2, David Swienton3, Thompson G Robinson1,2. 1. Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. 2. National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK. 3. Department of Radiology, University Hospitals of Leicester, Leicester, UK.
Abstract
BACKGROUND: Cerebral autoregulation is impaired in a multitude of neurological conditions. Increasingly, clinical studies are correlating the nature of this impairment with prognostic markers. In acute intracerebral hemorrhage, impairment of cerebral autoregulation has been associated with worsening clinical outcomes including poorer Glasgow Coma Score and larger hematoma volume. Hypocapnia has been shown to improve cerebral autoregulation despite concerns over hypoperfusion and consequent ischemic risks, and it is therefore hypothesized that hypocapnia (via hyperventilation) in acute intracerebral hemorrhage may improve cerebral autoregulation and consequently clinical outcome. AIMS: To assess the feasibility and acceptability of the first cerebral autoregulation-targeted intervention in acute intracerebral hemorrhage utilizing a simple bed-side hyperventilatory maneuver. METHODS: Twelve patients with acute intracerebral hemorrhage within 48 h of onset were enrolled. The experimental setup measured cerebral blood flow velocity (transcranial Doppler), blood pressure (Finometer), and end-tidal CO2 (EtCO2, capnography) at baseline, and in response to hypocapnia (-5 mmHg below baseline) achieved via a 90-s hyperventilatory maneuver. Cerebral autoregulation was evaluated with transfer function analysis and autoregulatory index calculations. RESULTS: We observed tolerance to the protocol in a cohort of mild (National Institutes of Health Scale 4) supratentorial intracerebral hemorrhage patients with small volume hematomas without intraventricular extension. Importantly, a significant difference was noted between ipsilateral autoregulatory index at baseline 4.8 (1.7) and autoregulatory index during hypocapnic intervention 7.0 (0.8) (p = 0.0004), reflecting improved cerebral autoregulation, though a dose-dependent effect of EtCO2 on autoregulatory index was not observed. CONCLUSIONS: In this small study, there was no observed effect on 14-day death and disability in recruited participants. This is the first report of improvement in cerebral autoregulation in acute intracerebral hemorrhage using a non-invasive interventional maneuver, through induction of hypocapnia via hyperventilation.ClinicalTrials.gov Identifier: NCT03324321URL: https://clinicaltrials.gov/ct2/show/NCT03324321.
BACKGROUND: Cerebral autoregulation is impaired in a multitude of neurological conditions. Increasingly, clinical studies are correlating the nature of this impairment with prognostic markers. In acute intracerebral hemorrhage, impairment of cerebral autoregulation has been associated with worsening clinical outcomes including poorer Glasgow Coma Score and larger hematoma volume. Hypocapnia has been shown to improve cerebral autoregulation despite concerns over hypoperfusion and consequent ischemic risks, and it is therefore hypothesized that hypocapnia (via hyperventilation) in acute intracerebral hemorrhage may improve cerebral autoregulation and consequently clinical outcome. AIMS: To assess the feasibility and acceptability of the first cerebral autoregulation-targeted intervention in acute intracerebral hemorrhage utilizing a simple bed-side hyperventilatory maneuver. METHODS: Twelve patients with acute intracerebral hemorrhage within 48 h of onset were enrolled. The experimental setup measured cerebral blood flow velocity (transcranial Doppler), blood pressure (Finometer), and end-tidal CO2 (EtCO2, capnography) at baseline, and in response to hypocapnia (-5 mmHg below baseline) achieved via a 90-s hyperventilatory maneuver. Cerebral autoregulation was evaluated with transfer function analysis and autoregulatory index calculations. RESULTS: We observed tolerance to the protocol in a cohort of mild (National Institutes of Health Scale 4) supratentorial intracerebral hemorrhagepatients with small volume hematomas without intraventricular extension. Importantly, a significant difference was noted between ipsilateral autoregulatory index at baseline 4.8 (1.7) and autoregulatory index during hypocapnic intervention 7.0 (0.8) (p = 0.0004), reflecting improved cerebral autoregulation, though a dose-dependent effect of EtCO2 on autoregulatory index was not observed. CONCLUSIONS: In this small study, there was no observed effect on 14-day death and disability in recruited participants. This is the first report of improvement in cerebral autoregulation in acute intracerebral hemorrhage using a non-invasive interventional maneuver, through induction of hypocapnia via hyperventilation.ClinicalTrials.gov Identifier: NCT03324321URL: https://clinicaltrials.gov/ct2/show/NCT03324321.
Authors: Shannon Hextrum; Jatinder S Minhas; Eric M Liotta; Farzaneh A Sorond; Andrew M Naidech; Matthew B Maas Journal: J Neurol Sci Date: 2020-09-12 Impact factor: 3.181
Authors: Ricardo C Nogueira; Marcel Aries; Jatinder S Minhas; Nils H Petersen; Li Xiong; Jana M Kainerstorfer; Pedro Castro Journal: J Cereb Blood Flow Metab Date: 2021-09-13 Impact factor: 6.960
Authors: Meshal Alharbi; Poppy Turner; Jonathan Ince; Mitsuhiro Oura; Kelechi U Ebirim; Alanoud Almudayni; Andrea Lecchini-Visintini; Jatinder S Minhas; Emma M L Chung Journal: Brain Sci Date: 2020-09-06
Authors: Johanna Laurikkala; Anders Aneman; Alexander Peng; Matti Reinikainen; Paul Pham; Pekka Jakkula; Johanna Hästbacka; Erika Wilkman; Pekka Loisa; Jussi Toppila; Thomas Birkelund; Kaj Blennow; Henrik Zetterberg; Markus B Skrifvars Journal: Crit Care Date: 2021-09-28 Impact factor: 9.097