Record ID

WUTe3a75531e4b1490394c6aa14a6471d30

Author

Ilaria Alice Crippa Ilaria Alice Crippa,, Undefined Affiliation

Jacques Creteur Jacques Creteur,, Undefined Affiliation

Peter Smielewski Peter Smielewski,, Undefined Affiliation

Fabio Silvio Taccone Fabio Silvio Taccone,, Undefined Affiliation

Marek Czosnyka Marek Czosnyka,, The Institute of Electronic Systems (FEIT/PE)Faculty of Electronics and Information Technology (FEIT)External affiliation of publication: University of Cambridge

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

2700 General Medicine; 2728 Clinical Neurology; 2746 Surgery

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

Ministerial score = 70.0, 15-09-2021, ArticleFromJournal

Publication indicators

Scopus SNIP: 2018 = 0.944; WoS Impact Factor: 2019 (2 years) = 1.530 - 2019 (5 years) =1.768

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