• Matthew Pesek, Kathleen Kibler, R Blaine Easley, Jennifer Mytar, Christopher Rhee, Dean Andropolous, and Ken Brady.
• Division of Pediatric Critical Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. mkpesek@texaschildrens.org.
• Acta Neurochir. Suppl. 2016 Jan 1; 122: 229-31.

BackgroundThe upper limit of cerebrovascular pressure autoregulation (ULA) is inadequately characterized. We sought to delineate the ULA in a neonatal swine model.MethodsNeonatal piglets with sham surgery (n = 9), interventricular fluid infusion (INF; n = 10), controlled cortical impact (CCI; n = 10), or impact + infusion (CCI + INF; n = 11) had intracranial pressure monitoring and bilateral cortical laser-Doppler flux recordings during arterial hypertension until lethality. An increase in red cell flux as a function of cerebral perfusion pressure was determined by piecewise linear regression and static rates of autoregulation (SRoRs) were determined above and below this inflection.ResultsWhen identified, the ULA (median [interquartile range]) was as follows: sham group: 102 mmHg (97-109), INF group: 75 mmHg (52-84), CCI group: 81 mmHg (69-101), and CCI + INF group: 61 mmHg (52-57; p = 0.01). Both groups with interventricular infusion had significantly lower ULA compared with the sham group.ConclusionNeonatal piglets without intracranial pathological conditions tolerated acute hypertension, with minimal perturbation of cerebral blood flow. Piglets with acutely elevated intracranial pressure, with or without trauma, demonstrated loss of autoregulation when subjected to arterial hypertension.

22 keywords...

hide…