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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00004512naa a2200469 4500
001oai:DiVA.org:umu-167904
003SwePub
008200205s2020 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1679042 URI
0247 a https://doi.org/10.1007/s12028-019-00885-32 DOI
040 a (SwePub)umu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Mathieu, François4 aut
2451 0a Relationship Between Measures of Cerebrovascular Reactivity and Intracranial Lesion Progression in Acute TBI Patients :b an Exploratory Analysis.
264 c 2019-12-03
264 1b Springer,c 2020
338 a electronic2 rdacarrier
520 a BACKGROUND: Failure of cerebral autoregulation and progression of intracranial lesion have both been shown to contribute to poor outcome in patients with acute traumatic brain injury (TBI), but the interplay between the two phenomena has not been investigated. Preliminary evidence leads us to hypothesize that brain tissue adjacent to primary injury foci may be more vulnerable to large fluctuations in blood flow in the absence of intact autoregulatory mechanisms. The goal of this study was therefore to assess the influence of cerebrovascular reactivity measures on radiological lesion expansion in a cohort of patients with acute TBI.METHODS: We conducted a retrospective cohort analysis on 50 TBI patients who had undergone high-frequency multimodal intracranial monitoring and for which at least two brain computed tomography (CT) scans had been performed in the acute phase of injury. We first performed univariate analyses on the full cohort to identify non-neurophysiological factors (i.e., initial lesion volume, timing of scan, coagulopathy) associated with traumatic lesion growth in this population. In a subset analysis of 23 patients who had intracranial recording data covering the period between the initial and repeat CT scan, we then correlated changes in serial volumetric lesion measurements with cerebrovascular reactivity metrics derived from the pressure reactivity index (PRx), pulse amplitude index (PAx), and RAC (correlation coefficient between the pulse amplitude of intracranial pressure and cerebral perfusion pressure). Using multivariate methods, these results were subsequently adjusted for the non-neurophysiological confounders identified in the univariate analyses.RESULTS: We observed significant positive linear associations between the degree of cerebrovascular reactivity impairment and progression of pericontusional edema. The strongest correlations were observed between edema progression and the following indices of cerebrovascular reactivity between sequential scans: % time PRx > 0.25 (r = 0.69, p = 0.002) and % time PAx > 0.25 (r = 0.64, p = 0.006). These associations remained significant after adjusting for initial lesion volume and mean cerebral perfusion pressure. In contrast, progression of the hemorrhagic core and extra-axial hemorrhage volume did not appear to be strongly influenced by autoregulatory status.CONCLUSIONS: Our preliminary findings suggest a possible link between autoregulatory failure and traumatic edema progression, which warrants re-evaluation in larger-scale prospective studies.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Neurologi0 (SwePub)302072 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Neurology0 (SwePub)302072 hsv//eng
653 a Neurophysiological monitoring
653 a Traumatic brain injury
653 a Traumatic intracranial hemorrhage
653 a Neurology
653 a neurologi
7001 a Zeiler, Frederick A.4 aut
7001 a Whitehouse, Daniel P.4 aut
7001 a Das, Tilak4 aut
7001 a Ercole, Ari4 aut
7001 a Smielewski, Peter4 aut
7001 a Hutchinson, Peter J.4 aut
7001 a Czosnyka, Marek4 aut
7001 a Newcombe, Virginia F. J.4 aut
7001 a Menon, David K..4 aut
7730 t Neurocritical Cared : Springerg 32:2, s. 373-382q 32:2<373-382x 1541-6933x 1556-0961
8564 u https://umu.diva-portal.org/smash/get/diva2:1391848/FULLTEXT02.pdfx primaryx Raw objecty fulltext:print
8564 u https://link.springer.com/content/pdf/10.1007/s12028-019-00885-3.pdf
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-167904
8564 8u https://doi.org/10.1007/s12028-019-00885-3

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