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Bedside Xenon-CT Shows Lower CBF in SAH Patients with Impaired CBF Pressure Autoregulation as Defined by Pressure Reactivity Index (PRx).
Neurocrit Care. 2016 08; 25(1):47-55.NC

Abstract

BACKGROUND

Subarachnoid hemorrhage (SAH) is a disease with a high rate of unfavorable outcome, often related to delayed cerebral ischemia (DCI), i.e., ischemic injury that develops days-weeks after onset, with a multifactorial etiology. Disturbances in cerebral pressure autoregulation, the ability to maintain a steady cerebral blood flow (CBF), despite fluctuations in systemic blood pressure, have been suggested to play a role in the development of DCI. Pressure reactivity index (PRx) is a well-established measure of cerebral pressure autoregulation that has been used to study traumatic brain injury, but not extensively in SAH.

OBJECTIVE

To study the relation between PRx and CBF in SAH patients, and to examine if PRx can be used to predict DCI.

METHODS

Retrospective analysis of prospectively collected data. PRx was calculated as the correlation coefficient between mean arterial blood pressure (MABP) and intracranial pressure (ICP) in a 5 min moving window. CBF was measured using bedside Xenon-CT (Xe-CT). DCI was diagnosed clinically.

RESULTS

47 poor-grade mechanically ventilated patients were studied. Patients with disturbed pressure autoregulation (high PRx values) had lower CBF, as measured by bedside Xe-CT; both in the early (day 0-3) and late (day 4-14) acute phase of the disease. PRx did not differ significantly between patients who developed DCI or not.

CONCLUSION

In mechanically ventilated and sedated SAH patients, high PRx (more disturbed CBF pressure autoregulation) is associated with low CBF, both day 0-3 and day 4-14 after onset. The role of PRx as a monitoring tool in SAH patients needs further studying.

Authors+Show Affiliations

Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden. ulf.johnson@neuro.uu.se. Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden. ulf.johnson@neuro.uu.se.Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden. Department of Surgical Sciences/Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden.Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26842717

Citation

Johnson, Ulf, et al. "Bedside Xenon-CT Shows Lower CBF in SAH Patients With Impaired CBF Pressure Autoregulation as Defined By Pressure Reactivity Index (PRx)." Neurocritical Care, vol. 25, no. 1, 2016, pp. 47-55.
Johnson U, Engquist H, Howells T, et al. Bedside Xenon-CT Shows Lower CBF in SAH Patients with Impaired CBF Pressure Autoregulation as Defined by Pressure Reactivity Index (PRx). Neurocrit Care. 2016;25(1):47-55.
Johnson, U., Engquist, H., Howells, T., Nilsson, P., Ronne-Engström, E., Lewén, A., Rostami, E., & Enblad, P. (2016). Bedside Xenon-CT Shows Lower CBF in SAH Patients with Impaired CBF Pressure Autoregulation as Defined by Pressure Reactivity Index (PRx). Neurocritical Care, 25(1), 47-55. https://doi.org/10.1007/s12028-016-0240-3
Johnson U, et al. Bedside Xenon-CT Shows Lower CBF in SAH Patients With Impaired CBF Pressure Autoregulation as Defined By Pressure Reactivity Index (PRx). Neurocrit Care. 2016;25(1):47-55. PubMed PMID: 26842717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bedside Xenon-CT Shows Lower CBF in SAH Patients with Impaired CBF Pressure Autoregulation as Defined by Pressure Reactivity Index (PRx). AU - Johnson,Ulf, AU - Engquist,Henrik, AU - Howells,Tim, AU - Nilsson,Pelle, AU - Ronne-Engström,Elisabeth, AU - Lewén,Anders, AU - Rostami,Elham, AU - Enblad,Per, PY - 2016/2/5/entrez PY - 2016/2/5/pubmed PY - 2017/10/24/medline KW - Cerebral blood flow KW - Cerebrovascular pressure reactivity KW - Hemorrhage KW - Monitoring KW - Subarachnoid KW - Xenon-CT SP - 47 EP - 55 JF - Neurocritical care JO - Neurocrit Care VL - 25 IS - 1 N2 - BACKGROUND: Subarachnoid hemorrhage (SAH) is a disease with a high rate of unfavorable outcome, often related to delayed cerebral ischemia (DCI), i.e., ischemic injury that develops days-weeks after onset, with a multifactorial etiology. Disturbances in cerebral pressure autoregulation, the ability to maintain a steady cerebral blood flow (CBF), despite fluctuations in systemic blood pressure, have been suggested to play a role in the development of DCI. Pressure reactivity index (PRx) is a well-established measure of cerebral pressure autoregulation that has been used to study traumatic brain injury, but not extensively in SAH. OBJECTIVE: To study the relation between PRx and CBF in SAH patients, and to examine if PRx can be used to predict DCI. METHODS: Retrospective analysis of prospectively collected data. PRx was calculated as the correlation coefficient between mean arterial blood pressure (MABP) and intracranial pressure (ICP) in a 5 min moving window. CBF was measured using bedside Xenon-CT (Xe-CT). DCI was diagnosed clinically. RESULTS: 47 poor-grade mechanically ventilated patients were studied. Patients with disturbed pressure autoregulation (high PRx values) had lower CBF, as measured by bedside Xe-CT; both in the early (day 0-3) and late (day 4-14) acute phase of the disease. PRx did not differ significantly between patients who developed DCI or not. CONCLUSION: In mechanically ventilated and sedated SAH patients, high PRx (more disturbed CBF pressure autoregulation) is associated with low CBF, both day 0-3 and day 4-14 after onset. The role of PRx as a monitoring tool in SAH patients needs further studying. SN - 1556-0961 UR - https://www.unboundmedicine.com/medline/citation/26842717/Bedside_Xenon_CT_Shows_Lower_CBF_in_SAH_Patients_with_Impaired_CBF_Pressure_Autoregulation_as_Defined_by_Pressure_Reactivity_Index__PRx__ L2 - https://dx.doi.org/10.1007/s12028-016-0240-3 DB - PRIME DP - Unbound Medicine ER -