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Delay of cerebral autoregulation in traumatic brain injury patients
Authors:
- Ilaria Alice Crippa,
- Jacques Creteur,
- Peter Smielewski,
- Fabio Silvio Taccone,
- Marek Czosnyka
- Record ID
- WUTe3a75531e4b1490394c6aa14a6471d30
- Author
- Journal series
- Clinical Neurology and Neurosurgery, ISSN 0303-8467, e-ISSN 1872-6968
- Issue year
- 2021
- Vol
- 202
- Pages
- 1-5
- Article number
- 106478
- Keywords in original language
- Traumatic brain injury Cerebral autoregulation Delayed Outcome
- ASJC Classification
- ; ;
- Abstract in original language
- Introduction Adequate cerebral perfusion prevents secondary insult after traumatic brain injury (TBI). Cerebral autoregulation (CAR) keeps cerebral blood flow (CBF) constant when arterial blood pressure (ABP) changes. Aim of the study was to evaluate the existence of delayed CAR in TBI patients and its possible association with outcome. Methods We retrospectively analysed TBI patients. Flow velocity (FV) in middle cerebral artery, invasive intra-cranial pressure (ICP) and ABP were recorded. Cerebral perfusion pressure (CPP) was calculated as ABP - ICP. Mean flow index (Mx) > 0.3 defined altered CAR. Samples from patients with altered CAR were further analysed: FV signal was shifted backward relative to CPP; Mx was calculated after each shift (MxD). Mx > 0.3 plus MxD ≤ 0.3 defined delayed CAR. Favourable outcome (FO) at 6 months was defined as Glasgow Outcome Scale 4−5. Results 154 patients were included. GCS was 6 [4–9], ICP was 14 [9–20] mmHg. Data on 6 months outcome were available for 131 patients: 104/131 patients (79 %) were alive; GOS was 4 [3–5]; 70/131 (53 %) had FO. Mx was 0.07 [−0.19 to 0.28] overall. Mx was lower in patients with FO compared others (0.00 [−0.21 to 0.20] vs 0.17 [−0.12 to 0.37], p = 0.02). 118 (77 %) patients had intact CAR and 36 (23 %) patients had altered CAR; 23 patients - 15 % of the general cohort and 64 % of patients with altered CAR - had delayed CAR. Delay in the autoregulatory response was 2 [1–4] seconds. 80/98 (82 %) of patients with intact CAR survived, compared to 16/21 (76 %) with delayed and 8/12 (67 %) with altered CAR (p = 0.20). 80/98 (58 %) patients with intact, 10/21 (48 %) patients with delayed and 3/12 (25 %) patients with altered CAR had FO (p = 0.03). Conclusion A subgroup of TBI patients with delayed CAR was identified. Delayed CAR was associated with better neurological outcome than altered CAR.
- DOI
- DOI:10.1016/j.clineuro.2021.106478 Opening in a new tab
- URL
- https://www.sciencedirect.com/science/article/pii/S0303846721000056?via%3Dihub Opening in a new tab
- Language
- eng (en) English
- Score (nominal)
- 70
- Score source
- journalList
- Score
- = 70.0, 15-09-2021, ArticleFromJournal
- Publication indicators
- : 2018 = 0.944; : 2019 (2 years) = 1.530 - 2019 (5 years) =1.768
- Uniform Resource Identifier
- https://repo.pw.edu.pl/info/article/WUTe3a75531e4b1490394c6aa14a6471d30/
- URN
urn:pw-repo:WUTe3a75531e4b1490394c6aa14a6471d30
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