Impaired Cerebral Autoregulation and 6-Month Outcome in Children with Severe Traumatic Brain Injury: Preliminary Findings

Vavilala, Monica S.; Muangman, Saipin; Tontisirin, Nuj; Fisk, Dana M.; Roscigno, Ceceila; Mitchell, Pamela H.; Kirkness, Catherine J.; Zimmerman, Jerry J.; Chesnut, Randall M.; Lam, Arthur M.

doi:10.1159/000094161

Cited by 80 publications

(52 citation statements)

References 38 publications

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“…MABP = mean arterial blood pressure. Lt = left; Rt = right; Vmca = middle cerebral artery flow velocity [110]. Table 1 Age and gender differences in b Tontisirin, et al [22] c Bode [19] …”

Section: Discussionmentioning

confidence: 99%

“…Adult studies report poor outcomes with permanent but variable outcomes with transient loss of autoregulation [109]. Impaired cerebral autoregulation has been associated with poor outcome after pediatric TBI [104,110], but there is a paucity of information in children. While the relationship between cerebral autoregulation and outcome is complex and incompletely understood, it is clinically important.…”

Section: Impaired Cerebral Pressure Autoregulationmentioning

confidence: 99%

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Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Udomphorn

Armstead

Vavilala

2008

Pediatric Neurology

127

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Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Cerebral autoregulation is often impaired following traumatic brain injury and may adversely impact poor outcome. Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. In this article, we discuss normal pediatric cerebral physiology and cerebrovascular pathophysiology following pediatric traumatic brain injury.

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“…MABP = mean arterial blood pressure. Lt = left; Rt = right; Vmca = middle cerebral artery flow velocity [110]. Table 1 Age and gender differences in b Tontisirin, et al [22] c Bode [19] …”

Section: Discussionmentioning

confidence: 99%

Section: Impaired Cerebral Pressure Autoregulationmentioning

confidence: 99%

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Udomphorn

Armstead

Vavilala

2008

Pediatric Neurology

127

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“…In health, this process protects the brain during transient changes in the arterial blood pressure (ABP) from diminished or excessive blood flow. Traumatic brain injury (TBI), [1][2][3] stroke, 4 meningitis, 5,6 cardiopulmonary bypass, and deep hypothermic circulatory arrest 7 are examples of insults that have been shown to impair pressure autoregulation and have large-scale clinical impact. An impairment of autoregulation narrows the range of blood pressures at which flow is matched to metabolic needs.…”

mentioning

confidence: 99%

Continuous Time-Domain Analysis of Cerebrovascular Autoregulation Using Near-Infrared Spectroscopy

Brady

Lee

Kibler

et al. 2007

Stroke

305

319

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Background and Purpose-Assessment of autoregulation in the time domain is a promising monitoring method for actively optimizating cerebral perfusion pressure (CPP) in critically ill patients. The ability to detect loss of autoregulatory vasoreactivity to spontaneous fluctuations in CPP was tested with a new time-domain method that used near-infrared spectroscopic measurements of tissue oxyhemoglobin saturation in an infant animal model. Methods-Piglets were made progressively hypotensive over 4 to 5 hours by inflation of a balloon catheter in the inferior vena cava, and the breakpoint of autoregulation was determined using laser-Doppler flowmetry. The cerebral oximetry index (COx) was determined as a moving linear correlation coefficient between CPP and INVOS cerebral oximeter waveforms during 300-second periods. A laser-Doppler derived time-domain analysis of spontaneous autoregulation with the same parameters (LDx) was also determined. Results-An increase in the correlation coefficient between cerebral oximetry values and dynamic CPP fluctuations, indicative of a pressure-passive relationship, occurred when CPP was below the steady state autoregulatory breakpoint. This COx had 92% sensitivity (73% to 99%) and 63% specificity (48% to 76%) for detecting loss of autoregulation attributable to hypotension when COx was above a threshold of 0.36. The area under the receiver-operator characteristics curve for the COx was 0.89. COx correlated with LDx when values were sorted and averaged according to the CPP at which they were obtained (rϭ0.67). Conclusions-The COx is sensitive for loss of autoregulation attributable to hypotension and is a promising monitoring tool for determining optimal CPP for patients with acute brain injury.

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“…Impaired cerebral autoregulation is common following TBI and has been reported in 29 to 63% of pediatric patients [60][61][62][63]. Young age (less than 5 years) appears to be a risk factor [64,65].…”

Section: Current Controversiesmentioning

confidence: 99%

“…Young age (less than 5 years) appears to be a risk factor [64,65]. Several studies have linked impaired cerebral autoregulation with poor outcome [61,66,67]. A recent study found only low systolic blood pressure and impaired cerebral autoregulation to be independently associated with poor outcome after multivariate analysis of multiple hemodynamic factors [68].…”

Section: Current Controversiesmentioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

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Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

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Impaired Cerebral Autoregulation and 6-Month Outcome in Children with Severe Traumatic Brain Injury: Preliminary Findings

Cited by 80 publications

References 38 publications

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Continuous Time-Domain Analysis of Cerebrovascular Autoregulation Using Near-Infrared Spectroscopy

Pediatric Neurocritical Care

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