Cerebral Autoregulation in Patients Treated With V-Vecmo For Severe Ards

Fanelli, Vito; Mazzeo, Anna Teresa; Battaglini, Iacopo; Caccia, Simone; Boffini, Massimo; Ricci, Davide; Qarra, Suad El; Izzo, Gennaro; Urbino, Rosario; Terragni, Pierpaolo; Brazzi, Luca; Rinaldi, Mauro; Ranieri, V. Marco; Mascia, Luciana

doi:10.1186/2197-425x-3-s1-a509

Cited by 3 publications

(2 citation statements)

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“…This perhaps reflects the multivariate nature of vascular dysregulation; indeed, previous investigations have shown disturbed cerebral vascular function during seemingly non-neurological scenarios such as impaired arterial glucose regulation, impaired kidney function, or after red blood cell transfusion [ 50 – 52 ]. In addition, common conditions in this group included sepsis, respiratory failure, and postresuscitation from cardiac arrest, all of which have been shown to be characterised by impaired cerebrovascular reactivity and resulting in high short-term mortality [ 53 – 56 ].…”

Section: Discussionmentioning

confidence: 99%

Temporal profile of intracranial pressure and cerebrovascular reactivity in severe traumatic brain injury and association with fatal outcome: An observational study

et al. 2017

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BackgroundBoth intracranial pressure (ICP) and the cerebrovascular pressure reactivity represent the dysregulation of pathways directly involved in traumatic brain injury (TBI) pathogenesis and have been used to inform clinical management. However, how these parameters evolve over time following injury and whether this evolution has any prognostic importance have not been studied.Methods and findingsWe analysed the temporal profile of ICP and pressure reactivity index (PRx), examined their relation to TBI-specific mortality, and determined if the prognostic relevance of these parameters was affected by their temporal profile using mixed models for repeated measures of ICP and PRx for the first 240 hours from the time of injury. A total of 601 adults with TBI, admitted between September 2002 to January 2016, and with high-resolution continuous monitoring from a single centre, were studied. At 6 months postinjury, 133 (19%) patients had a fatal outcome; of those, 88 (78%) died from nonsurvivable TBI or brain death. The difference in mean ICP between those with a fatal outcome and functional survivors was only significant for the first 168 hours after injury (all p < 0.05). For PRx, those patients with a fatal outcome also had a higher (more impaired) PRx throughout the first 120 hours after injury (all p < 0.05). The separation of ICP and PRx was greatest in the first 72 hours after injury. Mixed models demonstrated that the explanatory power of the PRx decreases over time; therefore, the prognostic weight assigned to PRx should similarly decrease. However, the ability of ICP to predict a fatal outcome remained relatively stable over time. As control of ICP is the central purpose of TBI management, it is likely that some of the information that is reflected in the natural history of ICP changes is no longer apparent because of therapeutic intervention.ConclusionsWe demonstrated the temporal evolution of ICP and PRx and their relationship with fatal outcome, indicating a potential early prognostic and therapeutic window. The combination of dynamic monitoring variables and their time profile improved prediction of outcome. Therefore, time-driven dynamic modelling of outcome in patients with severe TBI may allow for more accurate and clinically useful prediction models. Further research is needed to confirm and expand on these findings.

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Section: Discussionmentioning

confidence: 99%

Temporal profile of intracranial pressure and cerebrovascular reactivity in severe traumatic brain injury and association with fatal outcome: An observational study

et al. 2017

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“…Vasopressor and inotropic therapy at some point of the observation might explain this as well as the overall small percentages of ORx > 0.3 ( 22 ). Fanelli et al ( 23 ) reported the restoration of autoregulation after initiation of ECMO therapy. Kahl et al presented an association between hypocapnia and impaired cerebral autoregulation in SARS-CoV-2 patients while hypercapnia did not have an effect on autoregulation indices.…”

Section: Discussionmentioning

confidence: 99%

Increased impairment of cerebral autoregulation in COVID-19 associated pulmonary failure requiring extracorporeal membrane oxygenation

Thudium,

Kappler,

Oremek

et al. 2024

Front. Med.

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IntroductionCerebrovascular complications are feared but also commonly reported in patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) support therapy. Besides other reasons, a connection between impaired cerebral autoregulation and SARS-CoV-2 infection as a mechanism for an increase in cerebrovascular complications has been hypothesized.MethodsIn an observational single-center study, we investigated a cohort of 48 patients requiring veno-venous ECMO support therapy with (n = 31) and without SARS-CoV-2 infection (n = 17). Cerebral autoregulation was assessed with the cerebral oximetry-derived autoregulation index (ORx) based on a moving correlation between arterial pressure and cerebral oximetry.ResultsPatients with ECMO support therapy and SARS-CoV-2 experienced more time with impaired cerebral autoregulation than without SARS-CoV-2 [17 ± 9 vs. 13 ± 9% (p = 0.027)]. Patients with SARS-CoV-2 suffering from cerebrovascular complications had more time with impaired autoregulation than non SARS-CoV-2 patients with these complications (19 ± 9 vs. 10 ± 4%, p = 0.032).ConclusionOur results suggest a connection between SARS-CoV-2 and impaired cerebral autoregulation as well as cerebrovascular complications in SARS-CoV-2 patients.

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