Intracranial and Extracranial Injury Burden as Drivers of Impaired Cerebrovascular Reactivity in Traumatic Brain Injury

Zeiler, Frederick A.; Donnelly, Joseph E.; Nourallah, Basil; Thelin, Eric Peter; Calviello, Leanne; Smielewski, Peter; Czosnyka, Marek; Ercole, Ari; Menon, David

doi:10.1089/neu.2017.5595

Cited by 31 publications

(64 citation statements)

References 21 publications

(30 reference statements)

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“…This patient population has been previously described in studies pertaining to the definition of a new cerebrovascular reactivity index [27], characterizing critical thresholds of ICP derived reactivity indices [29], and the assessment of imaging correlates to impaired cerebrovascular reactivity in adult TBI [28]. This population has a detailed admission CT injury characteristic database that was created for the previous work on cerebrovascular reactivity [28].…”

Section: Methodsmentioning

confidence: 99%

“…This population has a detailed admission CT injury characteristic database that was created for the previous work on cerebrovascular reactivity [28]. This data is unique and provided the ability to evaluate the link between RAP and admission imaging characteristics.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, a comprehensive CT lesion/characteristic database was available for each admission CT scan. This database has been detailed in the previous publication by Zeiler et al [28]. This IC injury database consisted of

Continuous variables: midline shift (MLS), in millimeters (mm); largest lesion volume, in milliliters (mL); number of contusions; number of diffuse axonal injury (DAI) lesions; and total contusion volume, in mL.

…”

Section: Methodsmentioning

confidence: 99%

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Impaired cerebral compensatory reserve is associated with admission imaging characteristics of diffuse insult in traumatic brain injury

et al. 2018

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BackgroundContinuous assessment of cerebral compensatory reserve is possible using the moving correlation between pulse amplitude of intra-cranial pressure (AMP) and intra-cranial pressure (ICP), called RAP. Little is known about the behavior and associations of this index in adult traumatic brain injury (TBI). The goal of this study is to evaluate the association between admission cerebral imaging findings and RAP over the course of the acute intensive care unit stay.MethodsWe retrospectively reviewed 358 adult TBI patients admitted to the Addenbrooke’s Hospital, University of Cambridge, from March 2005 to December 2016. Only non-craniectomy patients were studied. Using archived high frequency physiologic signals, RAP was derived and analyzed over the first 48 h and first 10 days of recording in each patient, using grand mean, percentage of time above various thresholds, and integrated area under the curve (AUC) of RAP over time. Associations between these values and admission computed tomography (CT) injury characteristics were evaluated.ResultsThe integrated AUC, based on various thresholds of RAP, was statistically associated with admission CT markers of diffuse TBI and cerebral edema. Admission CT findings of cortical gyral effacement, lateral ventricle compression, diffuse cortical subarachnoid hemorrhage (SAH), thickness of cortical SAH, presence of bilateral contusions, and subcortical diffuse axonal injury (DAI) were all associated with AUC of RAP over time. Joncheere-Terpstra testing indicated a statistically significant increase in mean RAP AUC across ordinal categories of the abovementioned associated CT findings.ConclusionsRAP is associated with cerebral CT injury patterns of diffuse injury and edema, providing some confirmation of its potential measurement of cerebral compensatory reserve in TBI.Electronic supplementary materialThe online version of this article (10.1007/s00701-018-3681-y) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Section: Methodsmentioning

confidence: 99%

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Impaired cerebral compensatory reserve is associated with admission imaging characteristics of diffuse insult in traumatic brain injury

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“…28 Fourth, admission intracranial injury burden, as assessed using CT, has been demonstrated to be associated with worse cerebrovascular reactivity during the acute ICU stay. 97,98 In particular, specific injury patterns associated with acceleration/deceleration or shearing mechanisms display the strongest link to globally impaired vascular reactivity. 98 Such injury characteristics include presence of a subdural haematoma, traumatic subarachnoid haemorrhage, and sub-cortical diffuse axonal injury.…”

Section: Association With Patient and Injury Factorsmentioning

confidence: 99%

“…97,98 In particular, specific injury patterns associated with acceleration/deceleration or shearing mechanisms display the strongest link to globally impaired vascular reactivity. 98 Such injury characteristics include presence of a subdural haematoma, traumatic subarachnoid haemorrhage, and sub-cortical diffuse axonal injury. These findings suggest that these particular high energy injury mechanisms appear to predispose adult TBI patients to develop sustained impaired cerebrovascular reactivity during their ICU stay.…”

Section: Association With Patient and Injury Factorsmentioning

confidence: 99%

Continuous cerebrovascular reactivity monitoring in moderate/severe traumatic brain injury: a narrative review of advances in neurocritical care

Zeiler

Ercole

Czosnyka

et al. 2020

British Journal of Anaesthesia

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Impaired cerebrovascular reactivity in adult moderate and severe traumatic brain injury (TBI) is known to be associated with worse global outcome at 6e12 months. As technology has improved over the past decades, monitoring of cerebrovascular reactivity has shifted from intermittent measures, to experimentally validated continuously updating indices at the bedside. Such advances have led to the exploration of individualised physiologic targets in adult TBI management, such as optimal cerebral perfusion pressure (CPP) values, or CPP limits in which vascular reactivity is relatively intact. These targets have been shown to have a stronger association with outcome compared with existing consensus-based guideline thresholds in severe TBI care. This has sparked ongoing prospective trials of such personalised medicine approaches in adult TBI. In this narrative review paper, we focus on the concept of cerebral autoregulation, proposed mechanisms of control and methods of continuous monitoring used in TBI. We highlight multimodal cranial monitoring approaches for continuous cerebrovascular reactivity assessment, physiologic and neuroimaging correlates, and associations with outcome. Finally, we explore the recent 'state-of-the-art' advances in personalised physiologic targets based on continuous cerebrovascular reactivity monitoring, their benefits, and implications for future avenues of research in TBI.

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Neurocritical Care Monitoring in ICU: Measurement of the Cerebral Autoregulation by Transcranial Doppler (TCD)

Calviello

Czosnyka

2021

Neurosonology in Critical Care

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Points 1. Transcranial Doppler ultrasonography (TCD) is a simple tool that can be used to image the middle cerebral artery (MCA) after traumatic brain injury (TBI). 2. TCD measures cerebral blood flow velocity (CBFV) through the MCA and can alert clinicians to both structural and dynamic irregularities of cerebral vessels resultant from pathology. This information is vital to assessments of cerebral autoregulation, a balance between blood pressure and blood flow, that can be compromised by TBI. 3. TCD devices can be utilized in conjunction with pre-existing bedside monitors and can be connected to computerized data collection systems, such as ICM+ (Cambridge Enterprise, Ltd.). 4. Analysis of TCD-based data facilitates patient outcome prediction, with some parameters such as the autoregulation index (ARI) and the mean flow velocity index (Mx) acting as established surrogate indicators of either favorable or unfavorable clinical outcome. 5. Although TCD is both inexpensive and portable, the technique suffers from a lack of inter-operator validity and a reliance on intermittent monitoring sessions.

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Intracranial and Extracranial Injury Burden as Drivers of Impaired Cerebrovascular Reactivity in Traumatic Brain Injury

Cited by 31 publications

References 21 publications

Impaired cerebral compensatory reserve is associated with admission imaging characteristics of diffuse insult in traumatic brain injury

Impaired cerebral compensatory reserve is associated with admission imaging characteristics of diffuse insult in traumatic brain injury

Continuous cerebrovascular reactivity monitoring in moderate/severe traumatic brain injury: a narrative review of advances in neurocritical care

Neurocritical Care Monitoring in ICU: Measurement of the Cerebral Autoregulation by Transcranial Doppler (TCD)

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