Early Transcranial Doppler Evaluation of Cerebral Autoregulation Independently Predicts Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Rynkowski, Carla Bittencourt; Manoel, Airton Leonardo de Oliveira; Reis, Marcelo; Puppo, Corina; Worm, Paulo Valdeci; Zambonin, Diego; Bianchin, Marino Muxfeldt

doi:10.1007/s12028-019-00732-5

Cited by 23 publications

(25 citation statements)

References 49 publications

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“…In brief, middle cerebral artery (MCA) BFV is continuously measured by TCD. Autoregulatory responses are then measured following an alteration in CPP (the transmural pressure sensed by myogenic mechanisms): this is typically achieved in SAH patients by compressing the carotid artery ipsilateral to the insonified MCA (126)(127)(128)(129)(130)(131), although in some cases, a bilateral thigh cuff is utilized (132,133). Compression of the carotid artery (tailored to yield ∼30% reduction in MCA BFV) decreases CPP: after a brief period (usually 3-5 s), the compression is released.…”

Section: Dynamic Autoregulation Measurementmentioning

confidence: 99%

Cerebral Autoregulation in Subarachnoid Hemorrhage

2021

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Subarachnoid hemorrhage (SAH) is a devastating stroke subtype with a high rate of mortality and morbidity. The poor clinical outcome can be attributed to the biphasic course of the disease: even if the patient survives the initial bleeding emergency, delayed cerebral ischemia (DCI) frequently follows within 2 weeks time and levies additional serious brain injury. Current therapeutic interventions do not specifically target the microvascular dysfunction underlying the ischemic event and as a consequence, provide only modest improvement in clinical outcome. SAH perturbs an extensive number of microvascular processes, including the “automated” control of cerebral perfusion, termed “cerebral autoregulation.” Recent evidence suggests that disrupted cerebral autoregulation is an important aspect of SAH-induced brain injury. This review presents the key clinical aspects of cerebral autoregulation and its disruption in SAH: it provides a mechanistic overview of cerebral autoregulation, describes current clinical methods for measuring autoregulation in SAH patients and reviews current and emerging therapeutic options for SAH patients. Recent advancements should fuel optimism that microvascular dysfunction and cerebral autoregulation can be rectified in SAH patients.

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Section: Dynamic Autoregulation Measurementmentioning

confidence: 99%

Cerebral Autoregulation in Subarachnoid Hemorrhage

2021

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“…Cerebral autoregulation is often impaired in the first days after aSAH 19 and is associated with poor outcome 3,4,20 . Previous studies have primarily concentrated on the dynamic component of cerebral autoregulation in aSAH patients.…”

Section: Discussionmentioning

confidence: 99%

“…Dynamic and static autoregulation reflect rapid responses to changes in pressure pulsation and slow responses to changes in mean arterial pressure, respectively 1 . Previous studies have reported that impaired cerebral autoregulation in patients with aSAH predicts the development of radiological vasospasm and delayed cerebral ischemia (DCI); and may correlate with poor outcome 2‐4 …”

Section: Introductionmentioning

confidence: 99%

Cerebral autoregulation after aneurysmal subarachnoid haemorrhage. A preliminary study comparing dexmedetomidine to propofol and/or midazolam

Kallioinen

Posti

Rahi

et al. 2020

Acta Anaesthesiol Scand

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Background Cerebral autoregulation is often impaired after aneurysmal subarachnoid haemorrhage (aSAH). Dexmedetomidine is being increasingly used, but its effects on cerebral autoregulation in patients with aSAH have not been studied before. Dexmedetomidine could be a useful sedative in patients with aSAH as it enables neurological assessment during the infusion. The aim of this preliminary study was to compare the effects of dexmedetomidine on dynamic and static cerebral autoregulation with propofol and/or midazolam in patients with aSAH. Methods Ten patients were recruited. Dynamic and static cerebral autoregulation were assessed using transcranial Doppler ultrasound during propofol and/or midazolam infusion and then during three increasing doses of dexmedetomidine infusion (0.7, 1.0 and 1.4 μg/kg/h). Transient hyperaemic response ratio (THRR) and strength of autoregulation (SA) were calculated to assess dynamic cerebral autoregulation. Static rate of autoregulation (sRoR)% was calculated by using noradrenaline infusion to increase the mean arterial pressure 20 mm Hg above the baseline. Results Data from nine patients were analysed. Compared to baseline, we found no statistically significant changes in THRR or sROR%. THRR was (mean ± SD) 1.20 ± 0.14, 1.17 ± 0.13 (P = .93), 1.14 ± 0.09 (P = .72) and 1.19 ± 0.18 (P = 1.0) and sROR% was 150.89 ± 84.37, 75.22 ± 27.75 (P = .08), 128.25 ± 58.35 (P = .84) and 104.82 ± 36.92 (P = .42) at baseline and during 0.7, 1.0 and 1.4 μg/kg/h dexmedetomidine infusion, respectively. Dynamic SA was significantly reduced after 1.0 μg/kg/h dexmedetomidine (P = .02). Conclusions Compared to propofol and/or midazolam, dexmedetomidine did not alter static cerebral autoregulation in aSAH patients, whereas a significant change was observed in dynamic SA. Further and larger studies with dexmedetomidine in aSAH patients are warranted.

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“…Dicha evaluación se realiza con Doppler transcraneal, midiendo los cambios en la velocidad del flujo sanguíneo cerebral después de breve compresión de la arteria carótida común ipsilateral, catalogándose como normal cuando se verifica aumento mayor del 9 % de la velocidad sistólica basal. Se ha descrito menores resultados funcionales al alta hospitalaria cuando se registró deterioro de la autorregulación cerebral en las primeras 72 horas de ingreso 18 .…”

Section: Hemorragia Subaracnoidea (Hsa)unclassified

Aplicaciones clínicas de Doppler Transcraneal en Neurología y Cuidados Neuro críticos.

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Quezada²,

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2020

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En la actualidad el ultrasonido permite obtener en forma no invasiva imágenes de la mayoría de estructuras. A nivel cerebral, se puede acceder a la vasculatura y evaluar la hemodinamia. Es un estudio seguro, no utiliza radiación y se puede realizar a la cabecera del paciente, las veces necesarias, hasta en monitoreo continuo. La limitación es que necesita un operador y cerca del 5-20% de las personas poseen ventanas óseas temporales poco accesibles, por el grosor del hueso. Durante la realización del Doppler transcraneal, se debe seguir una serie de pasos. Tras localizar los vasos esperados, según la ventana y profundidad, se siguen las ondas espectrales en al menos dos puntos en cada arteria y se miden las velocidades de cada una. El objetivo de esta revisión fue describir las utilidades más frecuentes del doppler transcraneal en personas con enfermedades neurológicas y en pacientes en cuidados neurocríticos. Se realizó búsqueda con la palabra clave “Transcranial doppler” en PUBMED, MEDLINE y EMBASE. Se encontraron 13 000 publicaciones, en inglés y español, con menos de 10 años de antigüedad. Se sintetizaron las principales aplicaciones neurológicas del doppler transcraneal, como herramienta auxiliar en la detección de la presión endocraneana y la muerte cerebral.

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Early Transcranial Doppler Evaluation of Cerebral Autoregulation Independently Predicts Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Cited by 23 publications

References 49 publications

Cerebral Autoregulation in Subarachnoid Hemorrhage

Cerebral Autoregulation in Subarachnoid Hemorrhage

Cerebral autoregulation after aneurysmal subarachnoid haemorrhage. A preliminary study comparing dexmedetomidine to propofol and/or midazolam

Aplicaciones clínicas de Doppler Transcraneal en Neurología y Cuidados Neuro críticos.

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