Cargando…
The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis
BACKGROUND: Intravenous hypertonic saline is utilized commonly in critical care for treatment of acute or refractory elevations of intracranial pressure (ICP) in traumatic brain injury (TBI) patients. Though there is a clear understanding of the general physiological effects of a hypertonic saline s...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Vienna
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505542/ https://www.ncbi.nlm.nih.gov/pubmed/32959342 http://dx.doi.org/10.1007/s00701-020-04579-0 |
_version_ | 1783584835345842176 |
---|---|
author | Froese, Logan Dian, Joshua Batson, Carleen Gomez, Alwyn Unger, Bertram Zeiler, Frederick A. |
author_facet | Froese, Logan Dian, Joshua Batson, Carleen Gomez, Alwyn Unger, Bertram Zeiler, Frederick A. |
author_sort | Froese, Logan |
collection | PubMed |
description | BACKGROUND: Intravenous hypertonic saline is utilized commonly in critical care for treatment of acute or refractory elevations of intracranial pressure (ICP) in traumatic brain injury (TBI) patients. Though there is a clear understanding of the general physiological effects of a hypertonic saline solution over long periods of time, smaller epoch effects of hypertonic saline (HTS) have not been thoroughly analyzed. The aim of this study was to perform a direct evaluation of the high-frequency response of HTS on the cerebrovascular physiological responses in TBI. METHODS: We retrospectively reviewed our prospectively maintained adult TBI database for those with archived high-frequency cerebral physiology and available HTS treatment information. We evaluated different epochs of physiology around HTS bolus dosing, comparing pre- with post-HTS. We assessed for changes in slow fluctuations in ICP, pulse amplitude of ICP (AMP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), cerebrovascular reactivity (as measured through pressure reactivity index (PRx)), and cerebral compensatory reserve (correlation (R) between AMP (A) and ICP (P)). Comparisons of mean measures and percentage time above clinically relevant thresholds for the physiological parameters were compared pre- and post-HTS using descriptive statistics and Mann-Whitney U testing. We assessed for subgroups of physiological responses using latent profile analysis (LPA). RESULTS: Fifteen patients underwent 69 distinct bolus infusions of hypertonic saline. Apart from the well-documented decrease in ICP, there was also a reduction in AMP. The analysis of cerebrovascular reactivity response to HTS solution had two main effects. For patients with grossly impaired cerebrovascular reactivity pre-HTS (PRx > + 0.30), HTS bolus led to improved reactivity. However, for those with intact cerebrovascular reactivity pre-HTS (PRx < 0), HTS bolus demonstrated a trend towards more impaired reactivity. This indicates that HTS has different impacts, dependent on pre-bolus cerebrovascular status. There was no significant change in metrics of cerebral compensatory reserve. LPA failed to demonstrate any subgroups of physiological responses to HTS administration. CONCLUSIONS: The direct decrease in ICP and AMP confirms that a bolus dose of a HTS solution is an effective therapeutic agent for intracranial hypertension. However, in patients with intact autoregulation, hypertonic saline may impair cerebral hemodynamics. These findings regarding cerebrovascular reactivity remain preliminary and require further investigation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-020-04579-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7505542 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Vienna |
record_format | MEDLINE/PubMed |
spelling | pubmed-75055422020-09-23 The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis Froese, Logan Dian, Joshua Batson, Carleen Gomez, Alwyn Unger, Bertram Zeiler, Frederick A. Acta Neurochir (Wien) Original Article - Brain trauma BACKGROUND: Intravenous hypertonic saline is utilized commonly in critical care for treatment of acute or refractory elevations of intracranial pressure (ICP) in traumatic brain injury (TBI) patients. Though there is a clear understanding of the general physiological effects of a hypertonic saline solution over long periods of time, smaller epoch effects of hypertonic saline (HTS) have not been thoroughly analyzed. The aim of this study was to perform a direct evaluation of the high-frequency response of HTS on the cerebrovascular physiological responses in TBI. METHODS: We retrospectively reviewed our prospectively maintained adult TBI database for those with archived high-frequency cerebral physiology and available HTS treatment information. We evaluated different epochs of physiology around HTS bolus dosing, comparing pre- with post-HTS. We assessed for changes in slow fluctuations in ICP, pulse amplitude of ICP (AMP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), cerebrovascular reactivity (as measured through pressure reactivity index (PRx)), and cerebral compensatory reserve (correlation (R) between AMP (A) and ICP (P)). Comparisons of mean measures and percentage time above clinically relevant thresholds for the physiological parameters were compared pre- and post-HTS using descriptive statistics and Mann-Whitney U testing. We assessed for subgroups of physiological responses using latent profile analysis (LPA). RESULTS: Fifteen patients underwent 69 distinct bolus infusions of hypertonic saline. Apart from the well-documented decrease in ICP, there was also a reduction in AMP. The analysis of cerebrovascular reactivity response to HTS solution had two main effects. For patients with grossly impaired cerebrovascular reactivity pre-HTS (PRx > + 0.30), HTS bolus led to improved reactivity. However, for those with intact cerebrovascular reactivity pre-HTS (PRx < 0), HTS bolus demonstrated a trend towards more impaired reactivity. This indicates that HTS has different impacts, dependent on pre-bolus cerebrovascular status. There was no significant change in metrics of cerebral compensatory reserve. LPA failed to demonstrate any subgroups of physiological responses to HTS administration. CONCLUSIONS: The direct decrease in ICP and AMP confirms that a bolus dose of a HTS solution is an effective therapeutic agent for intracranial hypertension. However, in patients with intact autoregulation, hypertonic saline may impair cerebral hemodynamics. These findings regarding cerebrovascular reactivity remain preliminary and require further investigation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-020-04579-0) contains supplementary material, which is available to authorized users. Springer Vienna 2020-09-21 2020 /pmc/articles/PMC7505542/ /pubmed/32959342 http://dx.doi.org/10.1007/s00701-020-04579-0 Text en © Springer-Verlag GmbH Austria, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Original Article - Brain trauma Froese, Logan Dian, Joshua Batson, Carleen Gomez, Alwyn Unger, Bertram Zeiler, Frederick A. The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis |
title | The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis |
title_full | The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis |
title_fullStr | The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis |
title_full_unstemmed | The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis |
title_short | The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis |
title_sort | impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis |
topic | Original Article - Brain trauma |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505542/ https://www.ncbi.nlm.nih.gov/pubmed/32959342 http://dx.doi.org/10.1007/s00701-020-04579-0 |
work_keys_str_mv | AT froeselogan theimpactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT dianjoshua theimpactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT batsoncarleen theimpactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT gomezalwyn theimpactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT ungerbertram theimpactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT zeilerfredericka theimpactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT froeselogan impactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT dianjoshua impactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT batsoncarleen impactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT gomezalwyn impactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT ungerbertram impactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis AT zeilerfredericka impactofhypertonicsalineoncerebrovascularreactivityandcompensatoryreserveintraumaticbraininjuryanexploratoryanalysis |