Asymmetry of pressure autoregulation after traumatic brain injury.

Détails

ID Serval
serval:BIB_3BB4EF33A6B3
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Asymmetry of pressure autoregulation after traumatic brain injury.
Périodique
Journal of Neurosurgery
Auteur(s)
Schmidt E.A., Czosnyka M., Steiner L.A., Balestreri M., Smielewski P., Piechnik S.K., Matta B.F., Pickard J.D.
ISSN
0022-3085
Statut éditorial
Publié
Date de publication
2003
Peer-reviewed
Oui
Volume
99
Numéro
6
Pages
991-998
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
OBJECT: The aim of this study was to assess the asymmetry of autoregulation between the left and right sides of the brain by using bilateral transcranial Doppler ultrasonography in a cohort of patients with head injuries. METHODS: Ninety-six patients with head injuries comprised the study population. All significant intracranial mass lesions were promptly removed. The patients were given medications to induce sedation and paralysis, and artificial ventilation. Arterial blood pressure (ABP) and intracranial pressure (ICP) were monitored in an invasive manner. A strategy based on the patient's cerebral perfusion pressure (CPP = ABP - ICP) was applied: CPP was maintained at a level higher than 70 mm Hg and ICP at a level lower than 25 mm Hg. The left and right middle cerebral arteries were insonated daily, and bilateral flow velocities (FVs) were recorded. The correlation coefficient between the CPP and FV, termed Mx, was calculated and time-averaged over each recording period on both sides. An Mx close to 1 signified that slow fluctuations in CPP produced synchronized slow changes in FV, indicating a defective autoregulation. An Mx close to 0 indicated preserved autoregulation. Computerized tomography scans in all patients were reviewed; the side on which the major brain lesion was located was noted and the extent of the midline shift was determined. Outcome was measured 6 months after discharge. The left-right difference in the Mx between the hemispheres was significantly higher in patients who died than in those who survived (0.16 +/- 0.04 compared with 0.08 +/- 0.01; p = 0.04). The left-right difference in the Mx was correlated with a midline shift (r = -0.42; p = 0.03). Autoregulation was worse on the side of the brain where the lesion was located (p < 0.035). CONCLUSIONS: The left-right difference in autoregulation is significantly associated with a fatal outcome. Autoregulation in the brain is worse on the side ipsilateral to the lesion and on the side of expansion in cases in which there is a midline shift.
Mots-clé
Adolescent, Adult, Aged, Blood Pressure/physiology, Brain Injuries/physiopathology, Brain Injuries/radiography, Cerebrovascular Circulation/physiology, Cohort Studies, Female, Homeostasis/physiology, Humans, Intracranial Pressure/physiology, Male, Middle Aged, Severity of Illness Index, Tomography, X-Ray Computed, Treatment Outcome, Ultrasonography, Doppler, Transcranial
Pubmed
Web of science
Création de la notice
29/12/2009 18:03
Dernière modification de la notice
20/08/2019 14:31
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