The relationship between cerebral blood flow autoregulation and cerebrovascular pressure reactivity after traumatic brain injury.
BACKGROUND
Cerebrovascular pressure reactivity is the principal mechanism of cerebral autoregulation. Assessment of cerebral autoregulation can be performed by using the mean flow index (Mx) based on transcranial Doppler ultrasonography. Cerebrovascular pressure reactivity can be monitored by using the pressure reactivity index (PRx), which is based on intracranial pressure monitoring. From a practical point of view, PRx can be monitored continuously, whereas Mx can only be monitored in short periods when transcranial Doppler probes can be applied.


OBJECTIVE
To assess to what degree impairment in pressure reactivity (PRx) is associated with impairment in cerebral autoregulation (Mx).


METHODS
A database of 345 patients with traumatic brain injury was screened for data availability including simultaneous Mx and PRx monitoring. Absolute differences, temporal changes, and association with outcome of the 2 indices were analyzed.


RESULTS
A total of 486 recording sessions obtained from 201 patients were available for analysis. Overall a moderate correlation between Mx and PRx was found (r = 0.58; P < .001). The area under the receiver operator characteristic curve designed to detect the ability of PRx to predict impaired cerebral autoregulation was 0.700 (95% confidence interval: 0.607-0.880). Discrepancies between Mx and PRx were most pronounced at an intracranial pressure of 30 mm Hg and they were significantly larger for patients who died (P = .026). Both Mx and PRx were significantly lower at day 1 postadmission in patients who survived than in those who died (P < .01).


CONCLUSIONS
There is moderate agreement between Mx and PRx. Discrepancies between Mx and PRx are particularly significant in patients with sustained intracranial hypertension. However, for clinical purposes, there is only limited interchangeability between indices.
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Karol P
KP
Budohoski
Marek
M
Czosnyka
Nicolas
N
de Riva
Peter
P
Smielewski
John D
JD
Pickard
David K
DK
Menon
Peter J
PJ
Kirkpatrick
Andrea
A
Lavinio
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply*; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult