Effects of Norepinephrine, Propofol, and Hemoglobin Concentration on Dynamic Measurements of Cerebrovascular Reactivity in Acute Brain Injury
| Autor: | Steffen Fieuws, Samuel Klein, Bart Depreitere, Geert Meyfroidt |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male 030506 rehabilitation medicine.medical_specialty Intracranial Pressure cerebral autoregulation Cbf autoregulation Cerebral autoregulation hemoglobin concentration norepinephrine Norepinephrine (medication) Norepinephrine 03 medical and health sciences 0302 clinical medicine Cerebrovascular reactivity Internal medicine medicine Homeostasis Humans Propofol Aged Retrospective Studies Glycated Hemoglobin propofol business.industry Middle Aged brain injury Stroke Cerebrovascular autoregulation Brain Injuries Cerebrovascular Circulation Cardiology Female Neurology (clinical) Hemoglobin 0305 other medical science business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Journal of Neurotrauma. 38:506-512 |
| ISSN: | 1557-9042 0897-7151 |
| DOI: | 10.1089/neu.2020.7160 |
| Popis: | Effects of treatment-associated variables on cerebrovascular autoregulation (CA) in acute brain injury patients remain unclear. As deficient CA is associated with worse outcomes and ideas about CA-steered management are emerging, this question is relevant. We investigated effects of norepinephrine and propofol infusion rates and hemoglobin concentration on dynamic measurements of cerebrovascular reactivity as surrogate for CA. A retrospective analysis of 91 traumatic brain injury (TBI) and 13 stroke patients admitted to the intensive care unit (ICU) of the Leuven University Hospitals was performed. Low-resolution autoregulation index (LAx) and high-frequency pressure reactivity index (PRx) were calculated as measurements of cerebrovascular reactivity. Data was binned into 5-, 15-, and 60-min intervals. Bivariate time-series analysis using lagged cross-correlations were calculated after pre-whitening and differencing. Linear mixed models evaluated effects of age, gender, cardiovascular risk, brain comorbidity, Glasgow Coma Scale (GCS), pupil reactivity, and type of injury. Median dose of norepinephrine, propofol and hemoglobin concentration was 7.8 μg/kg/h (Q1 3.6-Q3 13.8), 3 mg/kg/h (Q1 1.9-Q3 4.3), and 9.2 g·dL-1 (Q1 8.2-Q3 10.5), respectively. Mean cross-correlations for 24 lags were close to zero and not significant for all variables. No significant differences as function of age, gender, cardiovascular risk, brain comorbidity, GCS, pupil reactivity, and type of injury were found. Dynamic intracranial pressure-based measurements of cerebrovascular reactivity in acute brain injured patients are not affected by gradually adjusted norepinephrine or propofol infusion rates or slow changes in hemoglobin concentration within the typical ranges during ICU admission. Future trials on cerebrovascular reactivity-steered management and treatment of CA impairment may not have to take these variables into account. ispartof: JOURNAL OF NEUROTRAUMA vol:38 issue:4 pages:506-512 ispartof: location:United States status: published |
| Databáze: | OpenAIRE |
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