Assessment of Cerebrovascular Autoregulation Using Regional Cerebral Blood Flow in Surgically Managed Brain Trauma Patients

Tackla, Ryan D.; Hinzman, Jason M.; Foreman, Brandon; Magner, Mark; Andaluz, Norberto; Hartings, Jed A.

doi:10.1007/s12028-015-0146-5

Cited by 18 publications

(12 citation statements)

References 30 publications

(42 reference statements)

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“…Autoregulation function during cerebral ischemia is the main physiological activity to maintain normal brain metabolism. Loss of autoregulation could result in disruption of brain metabolism, induction of brain edema, and increase the severity ( 25 ), which were consistent with our results on abnormal pial artery dilation, increasing cell apoptosis and severe motor function injury. The previous study has shown that salvinorin A treatment exerted vessel dilation function in normal brain tissue ( 9 ).…”

Section: Discussionsupporting

confidence: 91%

Salvinorin A preserves cerebral pial artery autoregulation after forebrain ischemia via the PI3K/AKT/cGMP pathway

Dong¹,

Wei²,

Ma³

et al. 2018

Braz J Med Biol Res

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This study aimed to investigate the protective effect of salvinorin A on the cerebral pial artery after forebrain ischemia and explore related mechanisms. Thirty Sprague-Dawley rats received forebrain ischemia for 10 min. The dilation responses of the cerebral pial artery to hypercapnia and hypotension were assessed in rats before and 1 h after ischemia. The ischemia reperfusion (IR) control group received DMSO (1 µL/kg) immediately after ischemia. Two different doses of salvinorin A (10 and 20 µg/kg) were administered following the onset of reperfusion. The 5th, 6th, and 7th groups received salvinorin A (20 µg/kg) and LY294002 (10 µM), L-NAME (10 μM), or norbinaltorphimine (norBIN, 1 μM) after ischemia. The levels of cGMP in the cerebrospinal fluid (CSF) were also measured. The phosphorylation of AKT (p-AKT) was measured in the cerebral cortex by western blot at 24 h post-ischemia. Cell necrosis and apoptosis were examined by hematoxylin-eosin staining (HE) and TUNEL staining, respectively. The motor function of the rats was evaluated at 1, 2, and 5 days post-ischemia. The dilation responses of the cerebral pial artery were significantly impaired after ischemia and were preserved by salvinorin A treatment. In addition, salvinorin A significantly increased the levels of cGMP and p-AKT, suppressed cell necrosis and apoptosis of the cerebral cortex and improved the motor function of the rats. These effects were abolished by LY294002, L-NAME, and norBIN. Salvinorin A preserved cerebral pial artery autoregulation in response to hypercapnia and hypotension via the PI3K/AKT/cGMP pathway.

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Section: Discussionsupporting

confidence: 91%

Salvinorin A preserves cerebral pial artery autoregulation after forebrain ischemia via the PI3K/AKT/cGMP pathway

Dong¹,

Wei²,

Ma³

et al. 2018

Braz J Med Biol Res

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“…Of the 25 articles included in this review, 17 are formal publications [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and 8 are meeting abstracts. 18,[28][29][30][31][32][33] Of these articles, 23 have a prospective 10,11, and 2 have a retrospective observational design.…”

Section: Study Description and Demographicsmentioning

confidence: 99%

“…The type of thermal diffusion device used was parenchymal in 16 studies [11][12][13][16][17][18][19][20]23,24,26,[30][31][32][33][34] and cortical for the remaining 9 studies. 10,14,15,21,22,25,[27][28][29] CBF measurements are reported in terms of mL/100 g/min.…”

Section: Thermal Diffusion Flowmetry Techniquementioning

confidence: 99%

“…Functional outcome was most commonly reported using the GOS or GOS-E at 3 months, 6 months, or at an unspecified interval. 11,15,16,19,22,24,25,27,30 That said, 2 studies only report mortality at an unspecified interval 10,14 and 15 studies do not report any functional outcome measure in relation to CBF parameters. 11,13,15,[17][18][19][20][21]23,26,28,33,34 Table 2 summarizes the studies on TDF and association with global patient outcome.…”

Section: Functional Outcome Studiesmentioning

confidence: 99%

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Continuous Thermal Diffusion-Based Cerebral Blood Flow Monitoring in Adult Traumatic Brain Injury: A Scoping Systematic Review

Mathieu

Khellaf

Thelin

et al. 2019

Journal of Neurotrauma

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Thermal diffusion flowmetry (TDF) is an appealing candidate for monitoring of cerebral blood flow (CBF) in neurocritical-care patients as it provides absolute measurements with a high temporal resolution, potentially allowing for bedside intervention that could mitigate secondary injury. We performed a systematic review of TDF-regional(r)CBF measurements and their association with (1) patient functional outcome, (2) other neurophysiological parameters, and (3) imaging-based tissue outcomes. We searched MEDLINE, EMBASE, SCOPUS, BIOSIS, GlobalHealth, and the Cochrane Databases from inception to October 2018 and relevant conference proceedings published over the last 5 years. Nine articles that explored the relationship between TDF-rCBF, mortality, and Glasgow Outcome Scale (GOS) or GOS-Extended (GOS-E) at various intervals were included. Despite being based on an overall weak body of evidence, our analysis suggests a link between sustained low or high CBF and poor functional outcome. Twenty-five studies reporting associations with neurophysiological parameters were included. The available data also point to an association between low or high TDF-rCBF and intracranial hypertension. TDF-rCBF appears to correlate well with regional brain tissue oxygenation measurements. We found no studies reporting on imaging-based tissue outcome in relation to TDF. In conclusion, despite being based on a relatively weak body of evidence, the available literature suggests a link between consistently abnormal TDF-rCBF values, intracranial hypertension, and poor functional outcome. TDF-rCBF also appears to correlate well with regional measurements of brain tissue oxygenation. Currently, such monitoring should be considered experimental, requiring much further evaluation prior to widespread adoption.

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“…2), allowing the effects of different therapies on the autoregulatory state to be assessed. Similar autoregulation indices between CPP and PbtO 2 27 and CPP and CBF 58 have been constructed, although they have not been validated to the same degree as PRx.…”

Section: Figmentioning

confidence: 99%

Unraveling the complexities of invasive multimodality neuromonitoring

Sinha¹,

Hudgins²,

Schuster³

et al. 2017

Neurosurgical Focus

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Acute brain injuries are a major cause of death and disability worldwide. Survivors of life-threatening brain injury often face a lifetime of dependent care, and novel approaches that improve outcome are sorely needed. A delayed cascade of brain damage, termed secondary injury, occurs hours to days and even weeks after the initial insult. This delayed phase of injury provides a crucial window for therapeutic interventions that could limit brain damage and improve outcome.A major barrier in the ability to prevent and treat secondary injury is that physicians are often unable to target therapies to patients’ unique cerebral physiological disruptions. Invasive neuromonitoring with multiple complementary physiological monitors can provide useful information to enable this tailored, precision approach to care. However, integrating the multiple streams of time-varying data is challenging and often not possible during routine bedside assessment.The authors review and discuss the principles and evidence underlying several widely used invasive neuromonitors. They also provide a framework for integrating data for clinical decision making and discuss future developments in informatics that may allow new treatment paradigms to be developed.

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Assessment of Cerebrovascular Autoregulation Using Regional Cerebral Blood Flow in Surgically Managed Brain Trauma Patients

Cited by 18 publications

References 30 publications

Salvinorin A preserves cerebral pial artery autoregulation after forebrain ischemia via the PI3K/AKT/cGMP pathway

Salvinorin A preserves cerebral pial artery autoregulation after forebrain ischemia via the PI3K/AKT/cGMP pathway

Continuous Thermal Diffusion-Based Cerebral Blood Flow Monitoring in Adult Traumatic Brain Injury: A Scoping Systematic Review

Unraveling the complexities of invasive multimodality neuromonitoring

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