Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure.

Autor:	Jijeh AMZ; Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Fatima A; Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia., Faraji MA; Department of Radiology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia., Hamadah HK; Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia., Shaath GA; Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2024 Apr 26; Vol. 6 (5), pp. e1083. Date of Electronic Publication: 2024 Apr 26 (Print Publication: 2024).
DOI:	10.1097/CCE.0000000000001083
Abstrakt:	Objectives: This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP. Design: A single-center prospective cohort study. Setting: The study was conducted in a cardiac center over 4 years (2019-2022). Patients: Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded. Interventions: Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24-48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured. Measurements and Main Results: TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10-16 mm Hg) to 15 mm Hg (IQR, 12-21 mm Hg) postoperatively ( p = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14-30 mm Hg) to 28 mm Hg (IQR, 22-38 mm Hg) postoperatively ( p = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar. Conclusions: Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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