Hemispheric differences in cerebral autoregulation in children with moderate and severe traumatic brain injury.
BACKGROUND
To examine hemispheric differences in cerebral autoregulation in children with traumatic brain injury (TBI). After IRB approval and consent, subjects underwent static cerebral autoregulation testing during the first 9 days after PICU admission. Cerebral autoregulation was quantified using the autoregulatory index (ARI).


RESULTS
Forty-two (27 M:15 F) children (10 +/- 5 years) with TBI and admission Glasgow coma scale score (5 +/- 2) were enrolled. Seven (54%) of the 13 children with focal TBI and 8 (28%) of 29 children with diffuse TBI had impairment or absence of cerebral autoregulation of at least one hemisphere. In patients with isolated focal TBI, ARI was lower (0.40 +/- 0.40 vs. 0.67 +/- 0.40; P = 0.03) in the side of TBI than in the unaffected hemisphere, but cerebral autoregulation was often impaired on the side without TBI or shift (5/13) on head CT. There was no difference in ARI between hemispheres in children with diffuse TBI, with or without superimposed focal lesions (P = 0.17). Patients with bilateral intact cerebral autoregulation tended to have higher 6 month Glasgow Outcome Score (GOS) than patients with either unilateral or bilateral cerebral autoregulation impairment (GOS 4.0 +/- 0.60 vs. 3.6 +/- 0.80; P = 0.08).


CONCLUSIONS
Hemispheric differences in cerebral autoregulation were common in children with isolated focal TBI. Absence of TBI on CT was not always associated with intact cerebral autoregulation. Patients with bilaterally intact cerebral autoregulation tended to have better outcomes.
Vavilala
Monica S
MS
Department of Anesthesiology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359724, Seattle, WA 98104, USA. vavilala@u.washington.edu
Tontisirin
Nuj
N
Udomphorn
Yuthana
Y
Armstead
William
W
Zimmerman
Jerry J
JJ
Chesnut
Randall
R
Lam
Arthur M
AM
D000293:Adolescent; D001783:Blood Flow Velocity; D001930:Brain Injuries / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D002560:Cerebrovascular Circulation; D002648:Child; D003422:Critical Care; D005260:Female; D007839:Functional Laterality; D015600:Glasgow Coma Scale; D006706:Homeostasis; D006801:Humans; D006940:Hyperemia / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D020768:Middle Cerebral Artery / Q000502:physiology; D015995:Prevalence; D016896:Treatment Outcome