Continuous assessment of cerebral autoregulation--clinical verification of the method in head injured patients.
Previously, using transcranial Doppler ultrasonography, we investigated whether the hemodynamic response to spontaneous variations in cerebral perfusion pressure (CPP) provides reliable information about cerebral autoregulatory reserve. In the present study we have verified this method in 166 patients after head trauma. Waveforms of intracranial pressure (ICP), arterial pressure and transcranial Doppler flow velocity (FV) were captured daily over 0.5-2.0 hour periods. Time-averaged mean flow velocity (FV) and CPP were resolved. The correlation coefficient indices between FV and CPP (Mx) were calculated over 3 minutes epochs, and averaged for each investigation. An index of CBF (flow velocity diastolic to mean ratio) was calculated independently for each investigation. Mx depended on CPP (p < 0.0001) increasing to positive values when CPP decreased below 60 mm Hg. This threshold coincided with an averaged breakpoint for autoregulation, expressed by the index of CBF. Mx depended on outcome following head injury stronger than the Glasgow Coma Score on admission (ANOVA, F values 18 and 15 respectively; N = 166). In patients who died, cerebral autoregulation was disturbed during the first two days following injury. These results indicate an important role for the continuous monitoring of autoregulation following head trauma.
Czosnyka
M
M
Academic Neurosurgical Unit & Wolfson Barain Imaging Centre, Department of Anaesthesiology, Addenbrooke's Hospital, Cambridge, UK.
Smielewski
P
P
Piechnik
S
S
Schmidt
E A
EA
Seeley
H
H
al-Rawi
P
P
Matta
B F
BF
Kirkpatrick
P J
PJ
Pickard
J D
JD
D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D001929:Brain Edema / Q000175:diagnosis* / Q000503:physiopathology; D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology; D023261:Glasgow Outcome Scale; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D011379:Prognosis; D017585:Ultrasonography, Doppler, Transcranial; D014655:Vascular Resistance / Q000502:physiology*