Dynamic autoregulatory response after severe head injury

Roman Hlatky, Yu Furuya, Alex B. Valadka, Jorge Gonzalez, Ari Chacko, Yasu Mizutani, Charles F. Contant, Claudia S. Robertson

Research output: Contribution to journalArticlepeer-review

70 Scopus citations

Abstract

Object. The purpose of this study was to evaluate the extent and timing of impairment of cerebral pressure autoregulation after severe head injury. Methods. In a prospective study of 122 patients with severe head trauma (median Glasgow Coma Scale Score 6), dynamic tests of pressure autoregulation were performed every 12 hours during the first 5 days postinjury and daily during the next 5 days. The autoregulatory index ([ARI] normal value 5 ± 1.1) was calculated for each test. The changes in the ARI over time were examined and compared with other physiological variables. The ARI averaged 2.8 ± 1.9 during the first 12 hours postinjury, and continued to decrease to a nadir of 1.7 ± 1.1 at 36 to 48 hours postinjury. At this nadir, in 87% of the patients the value was less than 2.8. This continued deterioration in the ARI during the first 36 to 48 hours postinjury occurred despite an increase in cerebral blood flow ([CBF], p < 0.05) and in middle cerebral artery blood flow velocity ([BFV], p < 0.001), and could not be explained by changes in cerebral perfusion pressure, end-tidal CO2, or cerebral metabolic rate of O2. A marked decrease in cerebrovascular resistance ([CVR], p < 0.001) accompanied this deterioration in the ARI. Patients with a relatively higher BFV on Day 1 had a lower CVR (p < 0.05) and more impaired pressure autoregulation than those with a lower BFV. Conclusion. The inability of cerebral vessels to regulate CBF normally may play a role in the vulnerability of the injured brain to secondary ischemic insults. These studies indicate that this vulnerability continues and even increases beyond the first 24 hours postinjury. Local factors affecting cerebrovascular tone may be responsible for these findings.

Original languageEnglish (US)
Pages (from-to)1054-1061
Number of pages8
JournalJournal of neurosurgery
Volume97
Issue number5
DOIs
StatePublished - Nov 1 2002
Externally publishedYes

Keywords

  • Autoregulation
  • Cerebral blood flow
  • Cerebrovascular resstance
  • Head injury
  • Transcranial Doppler ultrasonography

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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