Impact of Therapeutic Interventions on Cerebral Autoregulatory Function Following Severe Traumatic Brain Injury: A Secondary Analysis of the BOOST-II Study.

Blood pressure Brain tissue oxygen Cerebral autoregulation Cerebral perfusion pressure Traumatic brain injury

Journal

Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086

Informations de publication

Date de publication:
29 Dec 2023
Historique:
received: 01 05 2023
accepted: 17 11 2023
medline: 2 1 2024
pubmed: 2 1 2024
entrez: 29 12 2023
Statut: aheadofprint

Résumé

The Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase II randomized controlled trial used a tier-based management protocol based on brain tissue oxygen (PbtO Of the 119 patients enrolled in the Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase II trial, 55 patients had simultaneous recordings of arterial BP, ICP, and PbtO Individualized limits of autoregulation were computed in 55 patients (mean age 38 years, mean monitoring time 92 h). We identified 35 episodes of brain tissue hypoxia (PbtO Our analysis suggests that brain tissue hypoxia is associated with cerebral hypoperfusion characterized by increased time with CPP below the lower limit of autoregulation. Interventions to increase CPP appear to improve autoregulation. Further studies are needed to validate the importance of autoregulation as a modifiable variable with the potential to improve outcomes.

Sections du résumé

BACKGROUND BACKGROUND
The Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase II randomized controlled trial used a tier-based management protocol based on brain tissue oxygen (PbtO
METHODS METHODS
Of the 119 patients enrolled in the Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase II trial, 55 patients had simultaneous recordings of arterial BP, ICP, and PbtO
RESULTS RESULTS
Individualized limits of autoregulation were computed in 55 patients (mean age 38 years, mean monitoring time 92 h). We identified 35 episodes of brain tissue hypoxia (PbtO
CONCLUSIONS CONCLUSIONS
Our analysis suggests that brain tissue hypoxia is associated with cerebral hypoperfusion characterized by increased time with CPP below the lower limit of autoregulation. Interventions to increase CPP appear to improve autoregulation. Further studies are needed to validate the importance of autoregulation as a modifiable variable with the potential to improve outcomes.

Identifiants

DOI: 10.1007/s12028-023-01896-x PMID: 38158481
pubmed: 38158481
doi: 10.1007/s12028-023-01896-x
pii: 10.1007/s12028-023-01896-x
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

Références

Wang A, Ortega-Gutierrez S, Petersen NH. Autoregulation in the neuro ICU. Curr Treat Option Ne. 2018;20:20.
doi: 10.1007/s11940-018-0501-x
Czosnyka M, Miller C. Monitoring P in the IMCC on M. Monitoring of cerebral autoregulation. Neurocrit Care. 2014;21(Suppl 2):S95-102.
doi: 10.1007/s12028-014-0046-0 pubmed: 25208679
Roux PL, Menon DK, Citerio G, Vespa P, Bader MK, Brophy GM, et al. Consensus summary statement of the international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: a statement for healthcare professionals from the neurocritical care society and the European society of intensive care medicine. Neurocrit Care. 2014;21(Suppl 2):S1-26.
doi: 10.1007/s12028-014-0041-5 pubmed: 25208678 pmcid: 10596301
Aries MJH, Czosnyka M, Budohoski KP, Steiner LA, Lavinio A, Kolias AG, et al. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med. 2012;40:2456–63.
doi: 10.1097/CCM.0b013e3182514eb6 pubmed: 22622398
Donnelly J, Czosnyka M, Adams H, Robba C, Steiner LA, Cardim D, et al. Individualizing thresholds of cerebral perfusion pressure using estimated limits of autoregulation. Crit Care Med. 2017;45:1464–71.
doi: 10.1097/CCM.0000000000002575 pubmed: 28816837 pmcid: 5595234
Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, et al. Brain oxygen optimization in severe traumatic brain injury phase-II. Crit Care Med. 2017;45:1907–14.
doi: 10.1097/CCM.0000000000002619 pubmed: 29028696 pmcid: 5679063
Beqiri E, Smielewski P, Robba C, Czosnyka M, Cabeleira MT, Tas J, et al. Feasibility of individualised severe traumatic brain injury management using an automated assessment of optimal cerebral perfusion pressure: the COGiTATE phase II study protocol. BMJ Open. 2019;9:e030727.
doi: 10.1136/bmjopen-2019-030727 pubmed: 31542757 pmcid: 6756360
Liu X, Maurits NM, Aries MJH, Czosnyka M, Ercole A, Donnelly J, et al. Monitoring of optimal cerebral perfusion pressure in traumatic brain injured patients using a multi-window weighting algorithm. J Neurotraum. 2017;34:3081–8.
doi: 10.1089/neu.2017.5003
Depreitere B, Güiza F, den Berghe GV, Schuhmann MU, Maier G, Piper I, et al. Pressure autoregulation monitoring and cerebral perfusion pressure target recommendation in patients with severe traumatic brain injury based on minute-by-minute monitoring data. J Neurosurg. 2014;120:1451–7.
doi: 10.3171/2014.3.JNS131500 pubmed: 24745709
Bagiella E, Novack TA, Ansel B, Diaz-Arrastia R, Dikmen S, Hart T, et al. Measuring outcome in traumatic brain injury treatment trials. J Head Trauma Rehab. 2010;25:375–82.
doi: 10.1097/HTR.0b013e3181d27fe3
Marín-Caballos AJ, Murillo-Cabezas F, Cayuela-Domínguez A, Domínguez-Roldán JM, Rincón-Ferrari MD, Valencia-Anguita J, et al. Cerebral perfusion pressure and risk of brain hypoxia in severe head injury: a prospective observational study. Crit Care. 2005;9:R670.
doi: 10.1186/cc3822 pubmed: 16356218 pmcid: 1414023
Schmidt JM, Ko S-B, Helbok R, Kurtz P, Stuart RM, Presciutti M, et al. Cerebral perfusion pressure thresholds for brain tissue hypoxia and metabolic crisis after poor-grade subarachnoid hemorrhage. Stroke. 2011;42:1351–6.
doi: 10.1161/STROKEAHA.110.596874 pubmed: 21441155 pmcid: 3089891
Megjhani M, Weiss M, Ford J, Terilli K, Kastenholz N, Nametz D, et al. Optimal cerebral perfusion pressure and brain tissue oxygen in aneurysmal subarachnoid hemorrhage. Stroke. 2022.
Chang JJJ, Youn TS, Benson D, Mattick H, Andrade N, Harper CR, et al. Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury. Crit Care Med. 2009;37:283–90.
doi: 10.1097/CCM.0b013e318192fbd7 pubmed: 19050612
Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury fourth edition. Neurosurgery. 2017;80:6–15.
doi: 10.1227/NEU.0000000000001432 pubmed: 27654000
Chesnut R, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, et al. A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2020;46:919–29.
doi: 10.1007/s00134-019-05900-x pubmed: 31965267 pmcid: 7210240
Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2019;45:1783–94.
doi: 10.1007/s00134-019-05805-9 pubmed: 31659383 pmcid: 6863785
Aries MJH, Wesselink R, Elting JWJ, Donnelly J, Czosnyka M, Ercole A, et al. Enhanced visualization of optimal cerebral perfusion pressure over time to support clinical decision making. Crit Care Med. 2016;44:e996–9.
doi: 10.1097/CCM.0000000000001816 pubmed: 27270178
Silverman A, Kodali S, Strander S, Gilmore EJ, Kimmel A, Wang A, et al. Deviation from personalized blood pressure targets is associated with worse outcome after subarachnoid hemorrhage. Stroke. 2019;50:2729–37.
doi: 10.1161/STROKEAHA.119.026282 pubmed: 31495332 pmcid: 6756936
Petersen NH, Silverman A, Strander SM, Kodali S, Wang A, Sansing LH, et al. Fixed compared with autoregulation-oriented blood pressure thresholds after mechanical thrombectomy for ischemic stroke. Stroke. 2020;51:914–21.
doi: 10.1161/STROKEAHA.119.026596 pubmed: 32078493 pmcid: 7050651
Tas J, Beqiri E, van Kaam RC, Czosnyka M, Donnelly J, Haeren RH, et al. Targeting autoregulation-guided cerebral perfusion pressure after traumatic brain injury (COGiTATE): a feasibility randomized controlled clinical trial. J Neurotraum. 2021;38:2790–800.
doi: 10.1089/neu.2021.0197
Sorrentino E, Diedler J, Kasprowicz M, Budohoski KP, Haubrich C, Smielewski P, et al. Critical thresholds for cerebrovascular reactivity after traumatic brain injury. Neurocrit Care. 2012;16:258–66.
doi: 10.1007/s12028-011-9630-8 pubmed: 21964774
Czosnyka M, Czosnyka Z, Smielewski P. Pressure reactivity index: journey through the past 20 years. Acta Neurochir. 2017;159:2063–5.
doi: 10.1007/s00701-017-3310-1 pubmed: 28849287
Jaeger M, Schuhmann MU, Soehle M, Meixensberger J. Continuous assessment of cerebrovascular autoregulation after traumatic brain injury using brain tissue oxygen pressure reactivity&ast. Crit Care Med. 2006;34:1783–8.
doi: 10.1097/01.CCM.0000218413.51546.9E pubmed: 16625135
Owen B, Vangala A, Fritch C, Alsarah AA, Jones T, Davis H, et al. Cerebral autoregulation correlation with outcomes and spreading depolarization in aneurysmal subarachnoid hemorrhage. Stroke. 2022;53:1975–83.
doi: 10.1161/STROKEAHA.121.037184 pubmed: 35196873 pmcid: 9133018

Auteurs

Ayush Prasad (A)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA.

Emily J Gilmore (EJ)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA.

Jennifer A Kim (JA)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA.

Liza Begunova (L)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA.

Madelynne Olexa (M)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA.

Rachel Beekman (R)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA.

Guido J Falcone (GJ)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA.

Charles Matouk (C)

Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.

Santiago Ortega-Gutierrez (S)

Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA.

Nancy R Temkin (NR)

Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
Department of Biostatistics, University of Washington, Seattle, WA, USA.

Jason Barber (J)

Department of Biostatistics, University of Washington, Seattle, WA, USA.

Ramon Diaz-Arrastia (R)

Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Adam de Havenon (A)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA.

Nils H Petersen (NH)

Division of Neurocritical Care and Emergency, Department of Neurology, Yale University School of Medicine, 15 York St, LCI 1003, New Haven, CT, CT 06510, USA. nils.petersen@yale.edu.
ORCID: 0000-0001-9711-3340

Classifications MeSH