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Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis
BACKGROUND: Impaired cerebrovascular reactivity in adult traumatic brain injury (TBI) is known to be associated with poor outcome. However, there has yet to be an analysis of the association between the comprehensively assessed intracranial hypertension therapeutic intensity level (TIL) and cerebrov...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Vienna
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704258/ https://www.ncbi.nlm.nih.gov/pubmed/31240583 http://dx.doi.org/10.1007/s00701-019-03980-8 |
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author | Zeiler, Frederick A. Ercole, Ari Beqiri, Erta Cabeleira, Manuel Aries, Marcel Zoerle, Tommaso Carbonara, Marco Stocchetti, Nino Smielewski, Peter Czosnyka, Marek Menon, David K. |
author_facet | Zeiler, Frederick A. Ercole, Ari Beqiri, Erta Cabeleira, Manuel Aries, Marcel Zoerle, Tommaso Carbonara, Marco Stocchetti, Nino Smielewski, Peter Czosnyka, Marek Menon, David K. |
author_sort | Zeiler, Frederick A. |
collection | PubMed |
description | BACKGROUND: Impaired cerebrovascular reactivity in adult traumatic brain injury (TBI) is known to be associated with poor outcome. However, there has yet to be an analysis of the association between the comprehensively assessed intracranial hypertension therapeutic intensity level (TIL) and cerebrovascular reactivity. METHODS: Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived pressure reactivity index (PRx) as the moving correlation coefficient between slow-wave in ICP and mean arterial pressure, updated every minute. Mean daily PRx, and daily % time above PRx of 0 were calculated for the first 7 days of injury and ICU stay. This data was linked with the daily TIL-Intermediate scores, including total and individual treatment sub-scores. Daily mean PRx variable values were compared for each TIL treatment score via mean, standard deviation, and the Mann U test (Bonferroni correction for multiple comparisons). General fixed effects and mixed effects models for total TIL versus PRx were created to display the relation between TIL and cerebrovascular reactivity. RESULTS: A total of 249 patients with 1230 ICU days of high frequency physiology matched with daily TIL, were assessed. Total TIL was unrelated to daily PRx. Most TIL sub-scores failed to display a significant relationship with the PRx variables. Mild hyperventilation (p < 0.0001), mild hypothermia (p = 0.0001), high levels of sedation for ICP control (p = 0.0001), and use vasopressors for CPP management (p < 0.0001) were found to be associated with only a modest decrease in mean daily PRx or % time with PRx above 0. CONCLUSIONS: Cerebrovascular reactivity remains relatively independent of intracranial hypertension therapeutic intensity, suggesting inadequacy of current TBI therapies in modulating impaired autoregulation. These findings support the need for investigation into the molecular mechanisms involved, or individualized physiologic targets (ICP, CPP, or Co2) in order to treat dysautoregulation actively. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-019-03980-8) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6704258 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer Vienna |
record_format | MEDLINE/PubMed |
spelling | pubmed-67042582019-09-06 Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis Zeiler, Frederick A. Ercole, Ari Beqiri, Erta Cabeleira, Manuel Aries, Marcel Zoerle, Tommaso Carbonara, Marco Stocchetti, Nino Smielewski, Peter Czosnyka, Marek Menon, David K. Acta Neurochir (Wien) Original Article - Brain trauma BACKGROUND: Impaired cerebrovascular reactivity in adult traumatic brain injury (TBI) is known to be associated with poor outcome. However, there has yet to be an analysis of the association between the comprehensively assessed intracranial hypertension therapeutic intensity level (TIL) and cerebrovascular reactivity. METHODS: Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived pressure reactivity index (PRx) as the moving correlation coefficient between slow-wave in ICP and mean arterial pressure, updated every minute. Mean daily PRx, and daily % time above PRx of 0 were calculated for the first 7 days of injury and ICU stay. This data was linked with the daily TIL-Intermediate scores, including total and individual treatment sub-scores. Daily mean PRx variable values were compared for each TIL treatment score via mean, standard deviation, and the Mann U test (Bonferroni correction for multiple comparisons). General fixed effects and mixed effects models for total TIL versus PRx were created to display the relation between TIL and cerebrovascular reactivity. RESULTS: A total of 249 patients with 1230 ICU days of high frequency physiology matched with daily TIL, were assessed. Total TIL was unrelated to daily PRx. Most TIL sub-scores failed to display a significant relationship with the PRx variables. Mild hyperventilation (p < 0.0001), mild hypothermia (p = 0.0001), high levels of sedation for ICP control (p = 0.0001), and use vasopressors for CPP management (p < 0.0001) were found to be associated with only a modest decrease in mean daily PRx or % time with PRx above 0. CONCLUSIONS: Cerebrovascular reactivity remains relatively independent of intracranial hypertension therapeutic intensity, suggesting inadequacy of current TBI therapies in modulating impaired autoregulation. These findings support the need for investigation into the molecular mechanisms involved, or individualized physiologic targets (ICP, CPP, or Co2) in order to treat dysautoregulation actively. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-019-03980-8) contains supplementary material, which is available to authorized users. Springer Vienna 2019-06-25 2019 /pmc/articles/PMC6704258/ /pubmed/31240583 http://dx.doi.org/10.1007/s00701-019-03980-8 Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article - Brain trauma Zeiler, Frederick A. Ercole, Ari Beqiri, Erta Cabeleira, Manuel Aries, Marcel Zoerle, Tommaso Carbonara, Marco Stocchetti, Nino Smielewski, Peter Czosnyka, Marek Menon, David K. Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis |
title | Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis |
title_full | Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis |
title_fullStr | Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis |
title_full_unstemmed | Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis |
title_short | Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis |
title_sort | cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a center-tbi analysis |
topic | Original Article - Brain trauma |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704258/ https://www.ncbi.nlm.nih.gov/pubmed/31240583 http://dx.doi.org/10.1007/s00701-019-03980-8 |
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