Temporal Course of Dynamic Cerebral Autoregulation in Patients With Intracerebral Hemorrhage

Abstract

Reports of dCA in patients with ICH group are scarce, yet diverse. In a case-control study, a higher gain was observed within 3 days of ICH onset when compared with the healthy controls, indicating a less effective dCA during the acute stage. 7 In a recent study, researchers obtained serial measurements and stated that a higher bilateral gain could last 5 days Background and Purpose-Cerebral autoregulation is crucial in patients with intracerebral hemorrhage. Dynamic cerebral autoregulation is probably altered in acute intracerebral hemorrhage; however, the temporal course of dynamic cerebral autoregulation and its correlation with clinical factors and outcomes are poorly understood. Methods-Forty-three acute supratentorial intracerebral hemorrhage patients (53.7±10.0 years old, 30 men) were enrolled for serial measurements performed on days 1 to 2, 4 to 6, 10 to 12, and 30 days after ictus. Noninvasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously using transcranial Doppler and a servocontrolled plethysmograph, respectively. Transfer function analysis was used to derive the autoregulatory parameters, including phase difference (PD), gain, and the rate of recovery of cerebral blood flow velocity. Results were compared with healthy controls and correlated with clinical factors and the 90-day outcome. Results-PD did not differ between affected and unaffected hemispheres over time. A significant lower PD (indicating dynamic cerebral autoregulation impaired) was found in bilateral hemispheres on days 1 to 2, 4 to 6, and 10 to 12, followed by later recovery on day 30. Lower bilateral PD on days 1 to 2 was associated with poorer Glasgow Coma Scale score at that time. Lower affected-side PD on days 4 to 6 was an independent predictive value for a poorer modified Rankin Scale at 90 days. Conclusions-In patients with supratentorial intracerebral hemorrhage, dynamic cerebral autoregulation is bilaterally impaired lasting at least 10 to 12 days and recovers within a month. Individual PD value is associated with clinical status at acute stage and affected-side PD on days 4 to 6 can be an independent predictor for clinical outcome. after ictus, whereas a higher gain value was not associated with any clinical factors or outcome. 14 Serial index Mx (reflecting both static and dynamic CA) was also derived within 5 days after ICH onset. Although it was not generally impaired on the first day, a secondary decline between days 3 and 5 could possibly occur mainly on the affected side, and this may be associated with poorer clinical status and outcomes.15 Yet, the above studies all garnered attention toward the early stage after ICH, while ignoring the subacute and recovery stages. This left unresolved whether, when, and to what extent could the altered dCA be restored.Thus, in the present study, we sought to (1) investigate the time course of dCA in ICH patients with serial follow-ups, including 1 to 2 days after ictus and 3 additional time points within a month, and (2) explore th...

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“…Four studies detailed end‐tidal carbon dioxide (EtCO 2 ) values for acute ICH patients. These ranged from 34.3 to 34.9 mm Hg in the acute phase (<72 hours) and 34.7 to 35.2 mmHg in the chronic (>72 hours) phase . Studies provided varying detail for BP recordings, with three providing no data, three providing mean arterial pressure (MAP), and one providing systolic readings only.…”

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