Francisco Abecasis1, Celeste Dias2, Agnieszka Zakrzewska3, Vitor Oliveira4, Marek Czosnyka3,5. 1. Pediatric Intensive Care Unit, Faculdade de Medicina, Centro Hospitalar Universitário Lisboa Norte, Universidade de Lisboa, Lisbon, Portugal. francisco.abecasis@chln.min-saude.pt. 2. Intensive Care Department, Neurocritical Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal. 3. Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK. 4. Laboratory of Cerebral Ultrasound, Neurology Department, Faculdade de Medicina, Centro Hospitalar Universitário Lisboa Norte, Universidade de Lisboa, Lisbon, Portugal. 5. Institute of Electronic Systems, Warsaw University of Technology, Warszawa, Poland.
Abstract
PURPOSE: To study three different methods of monitoring cerebral autoregulation in children with severe traumatic brain injury. METHODS: Prospective cohort study of all children admitted to the pediatric intensive care unit at a university-affiliated hospital with severe TBI over a 4-year period to study three different methods of monitoring cerebral autoregulation: pressure-reactivity index (PRx), transcranial Doppler derived mean flow velocity index (Mx), and near-infrared spectroscopy derived cerebral oximetry index (COx). RESULTS: Twelve patients were included in the study, aged 5 months to 17 years old. An empirical regression analyzing dependence of PRx on cerebral perfusion pressure (CPP) displayed the classic U-shaped distribution, with low PRx values (< 0.3) reflecting intact auto-regulation, within the CPP range of 50-100 mmHg. The optimal CPP was 75-80 mmHg for PRx and COx. The correlation coefficients between the three indices were as follows: PRx vs Mx, r = 0.56; p < 0.0001; PRx vs COx, r = 0.16; p < 0.0001; and COx vs Mx, r = 0.15; p = 0.022. The mean PRx with a cutoff value of 0.3 predicted correctly long-term outcome (p = 0.015). CONCLUSIONS: PRx seems to be the most robust index to access cerebrovascular reactivity in children with TBI and has promising prognostic value. Optimal CPP calculation is feasible with PRx and COx.
PURPOSE: To study three different methods of monitoring cerebral autoregulation in children with severe traumatic brain injury. METHODS: Prospective cohort study of all children admitted to the pediatric intensive care unit at a university-affiliated hospital with severe TBI over a 4-year period to study three different methods of monitoring cerebral autoregulation: pressure-reactivity index (PRx), transcranial Doppler derived mean flow velocity index (Mx), and near-infrared spectroscopy derived cerebral oximetry index (COx). RESULTS: Twelve patients were included in the study, aged 5 months to 17 years old. An empirical regression analyzing dependence of PRx on cerebral perfusion pressure (CPP) displayed the classic U-shaped distribution, with low PRx values (< 0.3) reflecting intact auto-regulation, within the CPP range of 50-100 mmHg. The optimal CPP was 75-80 mmHg for PRx and COx. The correlation coefficients between the three indices were as follows: PRx vs Mx, r = 0.56; p < 0.0001; PRx vs COx, r = 0.16; p < 0.0001; and COx vs Mx, r = 0.15; p = 0.022. The mean PRx with a cutoff value of 0.3 predicted correctly long-term outcome (p = 0.015). CONCLUSIONS: PRx seems to be the most robust index to access cerebrovascular reactivity in children with TBI and has promising prognostic value. Optimal CPP calculation is feasible with PRx and COx.
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