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Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study
Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to asses...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301789/ https://www.ncbi.nlm.nih.gov/pubmed/34208937 http://dx.doi.org/10.3390/brainsci11070874 |
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author | Brasil, Sérgio Taccone, Fabio Silvio Wayhs, Sâmia Yasin Tomazini, Bruno Martins Annoni, Filippo Fonseca, Sérgio Bassi, Estevão Lucena, Bruno Nogueira, Ricardo De Carvalho De-Lima-Oliveira, Marcelo Bor-Seng-Shu, Edson Paiva, Wellingson Turgeon, Alexis Fournier Jacobsen Teixeira, Manoel Malbouisson, Luiz Marcelo Sá |
author_facet | Brasil, Sérgio Taccone, Fabio Silvio Wayhs, Sâmia Yasin Tomazini, Bruno Martins Annoni, Filippo Fonseca, Sérgio Bassi, Estevão Lucena, Bruno Nogueira, Ricardo De Carvalho De-Lima-Oliveira, Marcelo Bor-Seng-Shu, Edson Paiva, Wellingson Turgeon, Alexis Fournier Jacobsen Teixeira, Manoel Malbouisson, Luiz Marcelo Sá |
author_sort | Brasil, Sérgio |
collection | PubMed |
description | Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00–1.28] vs. 1.00 [0.88–1.16]; p = 0.03) and eICP (14 [11–25] vs. 11 [7–15] mmHg; p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8–12] vs. 6 [5–7]; p < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75–0.97); a score > 8.5 had 63 (46–77)% sensitivity and 87 (62–97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5–31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome. |
format | Online Article Text |
id | pubmed-8301789 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-83017892021-07-24 Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study Brasil, Sérgio Taccone, Fabio Silvio Wayhs, Sâmia Yasin Tomazini, Bruno Martins Annoni, Filippo Fonseca, Sérgio Bassi, Estevão Lucena, Bruno Nogueira, Ricardo De Carvalho De-Lima-Oliveira, Marcelo Bor-Seng-Shu, Edson Paiva, Wellingson Turgeon, Alexis Fournier Jacobsen Teixeira, Manoel Malbouisson, Luiz Marcelo Sá Brain Sci Article Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00–1.28] vs. 1.00 [0.88–1.16]; p = 0.03) and eICP (14 [11–25] vs. 11 [7–15] mmHg; p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8–12] vs. 6 [5–7]; p < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75–0.97); a score > 8.5 had 63 (46–77)% sensitivity and 87 (62–97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5–31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome. MDPI 2021-06-30 /pmc/articles/PMC8301789/ /pubmed/34208937 http://dx.doi.org/10.3390/brainsci11070874 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Brasil, Sérgio Taccone, Fabio Silvio Wayhs, Sâmia Yasin Tomazini, Bruno Martins Annoni, Filippo Fonseca, Sérgio Bassi, Estevão Lucena, Bruno Nogueira, Ricardo De Carvalho De-Lima-Oliveira, Marcelo Bor-Seng-Shu, Edson Paiva, Wellingson Turgeon, Alexis Fournier Jacobsen Teixeira, Manoel Malbouisson, Luiz Marcelo Sá Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
title | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
title_full | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
title_fullStr | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
title_full_unstemmed | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
title_short | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
title_sort | cerebral hemodynamics and intracranial compliance impairment in critically ill covid-19 patients: a pilot study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301789/ https://www.ncbi.nlm.nih.gov/pubmed/34208937 http://dx.doi.org/10.3390/brainsci11070874 |
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