Research Article
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Published Online: 8 July 2004

Noninvasive Cerebrovascular Autoregulation Assessment in Traumatic Brain Injury: Validation and Utility

Publication: Journal of Neurotrauma
Volume 20, Issue Number 1

Abstract

A moving correlation index (Mx-CPP) of cerebral perfusion pressure (CPP) and mean middle cerebral artery blood flow velocity (CBFV) allows continuous monitoring of dynamic cerebral autoregulation (CA) in patients with severe traumatic brain injury (TBI). In this study we validated Mx-CPP for TBI, examined its prognostic relevance, and assessed its relationship with arterial blood pressure (ABP), CPP, intracranial pressure (ICP), and CBFV. We tested whether using ABP instead of CPP for Mx calculation (Mx-ABP) produces similar results. Mx was calculated for each hemisphere in 37 TBI patients during the first 5 days of treatment. All patients received sedation and analgesia. CPP and bilateral CBFV were recorded, and GOS was estimated at discharge. Both Mx indices were calculated from 10,000 data points sampled at 57.4Hz. Mx-CPP > 0.3 indicates impaired CA; in these patients CPP had a significant positive correlation with CBFV, confirming failure of CA, while in those with Mx < 0.3, CPP was not correlated with CBFV, indicating intact CA. These findings were confirmed for Mx-ABP. We found a significant correlation between impaired CA, indicated by Mx-CPP and Mx-ABP, and poor outcome for TBI patients. ABP, CPP, ICP, and CBFV were not correlated with CA but it must be noted that our average CPP was considerably higher than in other studies. This study confirms the validity of this index to demonstrate CA preservation or failure in TBI. This index is also valid if ABP is used instead of CPP, which eliminates the need for invasive ICP measurements for CA assessment. An unfavorable outcome is associated with early CA failure. Further studies using the Mx-ABP will reveal whether CA improves along with patients' clinical improvement.

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cover image Journal of Neurotrauma
Journal of Neurotrauma
Volume 20Issue Number 1January 2003
Pages: 69 - 75
PubMed: 12614589

History

Published online: 8 July 2004
Published in print: January 2003

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Erhard W. Lang
Department of Neurosurgery, University of Sydney, Westmead Hospital, Sydney, Australia
Jim Lagopoulos
Department of Neurology, University of Sydney, Westmead Hospital, Sydney, Australia
Jane Griffith
Department of Neurosurgery, University of Sydney, Westmead Hospital, Sydney, Australia
Kwok Yip
Department of Neurosurgery, University of Sydney, Westmead Hospital, Sydney, Australia
Yugan Mudaliar
Department of Intensive Care, University of Sydney, Westmead Hospital, Sydney, Australia
H. Maximilian Mehdorn
Department of Neurosurgery, Christian-Albrechts-Universität, Kiel, Germany
Nicholas W.C. Dorsch
Department of Neurosurgery, University of Sydney, Westmead Hospital, Sydney, Australia

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