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Titolo:
Cerebral autoregulation testing after aneurysmal subarachnoid hemorrhage: The phase relationship between arterial blood pressure and cerebral blood flow velocity
Autore:
Lang, EW; Diehl, RR; Mehdorn, HM;
Indirizzi:
Univ Kiel, Dept Neurosurg, Kiel, Germany Univ Kiel Kiel GermanyUniv Kiel, Dept Neurosurg, Kiel, Germany Alfried Krupp Krankenhaus, Dept Neurol, Essen, Germany Alfried Krupp Krankenhaus Essen Germany us, Dept Neurol, Essen, Germany
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 1, volume: 29, anno: 2001,
pagine: 158 - 163
SICI:
0090-3493(200101)29:1<158:CATAAS>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
HEAD-INJURED PATIENTS; TRANSCRANIAL DOPPLER ULTRASOUND; HYPEREMIC RESPONSE TEST; INTRACRANIAL-PRESSURE; PERFUSION-PRESSURE; NIMODIPINE; VASOSPASM; OSCILLATIONS; REACTIVITY; HUMANS;
Keywords:
brain; monitoring; arterial blood pressure waves; cerebral blood flow velocity waves; dynamic cerebral pressure; autoregulation; transcranial Doppler ultrasound; subarachnoid hemorrhage; outcome; cerebrovascular circulation; vasospasm; cerebral perfusion pressure;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
37
Recensione:
Indirizzi per estratti:
Indirizzo: Lang, EW Westmead Hosp, Dept Neurosurg, Level 5, Westmead, NSW 2145, Australia Westmead Hosp Level 5 Westmead NSW Australia 2145 2145, Australia
Citazione:
E.W. Lang et al., "Cerebral autoregulation testing after aneurysmal subarachnoid hemorrhage: The phase relationship between arterial blood pressure and cerebral blood flow velocity", CRIT CARE M, 29(1), 2001, pp. 158-163

Abstract

Objective: Impairment of cerebral autoregulation (CA) appears to he an important cause for secondary ischemia after subarachnoid hemorrhage (SAH). Ithas been shown that graded CA impairment is predictive of outcome. Little is known about whether such impairment is present, what causes GA impairment, whether it precedes vasospasm, and whether it is predictive of outcome in patients with severe aneurysmal SAH. Design: Prospective, controlled study. Setting: Neurosurgical intensive care unit. Patients: Twelve patients after aneurysmal subarachnoid hemorrhage, 40 controls. Interventions: Recording of cerebral blood flow Velocities and continuous measurement of arterial blood pressure at a controlled ventilatory frequency of six per minute to standardize the influence of intrathoracic pressure changes on blood pressure. Measurements and Main Results: We calculated the phase shift angles (Deltaphi degrees) between slow (0.1 Hz) arterial blood pressure and cerebral blood flow velocity waves measured by transcranial Doppler ultrasound in the middle cerebral artery during a) posthemorrhage days (PHD) 1-6 (early or prevasospasm phase), and b) during PHD 7-13 (late or vasospasm phase) using a6/min ventilation protocol, and in 40 controls spontaneously ventilating at the same rate. Delta phi <30<degrees> indicated lost CA. Mean flow velocities >100 cm/sec were considered vasospasm. We combined early and late measurements to assess the CA relationship with low cerebral perfusion pressure(cPP) and/or vasospasm. We assessed the Glasgow Outcome Scale (GOS) score at discharge (1 = worst, 5 = best). The admission Hunt and Hess score was 3.6 +/- 0.7. GOS scores were n = 3 (GOS 1), n = 2 (GOS 2), n = 5 (GOS 3), n = 1 (GOS 4), and n = 1 (GOS 5). In the early phase, Delta phi was 40.4 +/- 19.8 degrees (left), and 40.4 +/- 19.2 degrees (right). CPP was 69.4 +/- 10.9, intracranial pressure (ICP) was6.7 +/- 2.8 mm Hg. In the late phase, Delta phi worsened in six patients and none improved: 32.1 +/- 21 degrees (left), and 26.9 +/- 17.2 degrees (right); CPP was 68.1 +/- 12.1, ICP was 7.5 +/- 3.7 mm Hg. GA was significantly impaired in both phases when compared with normal subjects (Delta phi: 65.7 +/- 24.5 degrees; p <.01 for early, p <.001 for late phase). In the early phase, seven of eight patients in whom autoregulation was intact had a GOS >2 at discharge and disturbed GA on at least one side was predictive of either vegetative condition at discharge or death (p <.01). In the late phase, <Delta>phi was no longer predictive of outcome. Spasm was present in 8 of 17 vessels (47%) in which GA was lost; no spasm was found in 25 of 28 vessels (89%) in which CA was intact (p <.01). A low CPP was present in 6 of 17 Vessels (35%) in which CA was lost; a normal CPP was found in 21 of 27 vessels (78%) in which CA was intact (p >.05, NS). However, 14 of 17 vessels (82%) with lost GA showed spasm and/or low CPP while only 8 of 27 Gases (30%) with intact CA had either spasm or low CPP (p <.001). Conclusions: CA can he assessed in a graded fashion in SAH patients. GA impairment precedes vasospasm; ongoing vasospasm worsens CA. CA assessment early after subarachnoid hemorrhage, within PHD 1-6, is predictive of outcomewhereas late assessment is not. GA impairment is associated with cerebral vasospasm and low CPP.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/10/20 alle ore 15:57:14