• Aidanas Preiksaitis, Solventa Krakauskaite, Vytautas Petkus, Saulius Rocka, Romanas Chomskis, Teodoro Forcht Dagi, and Arminas Ragauskas.
• *Clinic of Neurology and Neurosurgery at Faculty of Medicine at Vilnius University, Vilnius, Lithuania; ‡Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania; §Health Telematics Science Institute at Kaunas University of Technology, Kaunas, Lithuania; ¶Harvard Medical School at Harvard University, Cambridge, Massachusetts.
• Neurosurgery. 2016 Jul 1; 79 (1): 75-82.

BackgroundCerebrovascular autoregulation (CA) is an important hemodynamic mechanism that protects the brain against inappropriate fluctuations in cerebral blood flow in the face of changing cerebral perfusion pressure. Temporal CA failure is associated with worse outcomes in various acute neurological diseases. An integrative approach is presently used according to the existing paradigm for the association of series of temporal CA impairments with the outcomes of patients with traumatic brain injury (TBI).ObjectiveTo explore the influence of the duration of CA impairment events on severe TBI patient outcomes. Patient age was also included in the analysis of the prospectively collected clinical data.MethodsCA monitoring included 33 prospective severe TBI patients. The pressure reactivity index [PRx(t)] was continuously monitored to collect information on the dynamics of CA status and to analyze associations between the duration of the longest CA impairment event and patient outcomes.ResultsThe Glasgow outcome scale and the duration of the longest CA impairment were negatively correlated. The duration of autoregulation impairment significantly correlated with worse outcomes. Multidimensional representation of Glasgow outcome scale plots showed that better outcomes were obtained for younger patients (age < 47 years) and those whose longest CA impairment event was shorter than 40 minutes if PRx(t) was above 0.7 in the CA impairment event.ConclusionUnfavorable outcomes for TBI patients are more significantly associated with the duration of the single longest CA impairment episode at a high PRx(t) value, rather than with averaged PRx(t) values or the average time of all CA impairment episodes.AbbreviationsABP, arterial blood pressureABP(t), continuous reference arterial blood pressureCA, cerebrovascular autoregulationCBF, cerebral blood flowCPP, cerebral perfusion pressureGOS, Glasgow outcome scaleGOSHD, Glasgow outcome scale after hospital dischargeGOS6M, Glasgow outcome scale at 6 months after dischargeICP, intracranial pressureICP(t), continuously monitored intracranial pressureLCAI, longest CA impairmentoptCPP, optimal cerebral perfusion pressurePRx(t), pressure reactivity indexTBI, traumatic brain injury.

44 keywords...

hide…