Time course for autoregulation recovery following severe traumatic brain injury

Clinical article

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Object

The aim of the present study was to evaluate the time course for cerebral autoregulation (AR) recovery following severe traumatic brain injury (TBI)

Methods

Thirty-six patients (27 males and 9 females, mean ± SEM age 33 ± 15.1 years) with severe TBI underwent serial dynamic AR studies with leg cuff deflation as a stimulus, until recovery of the AR responses was measured.

Results

The AR was impaired (AR index < 2.8) in 30 (83%) of 36 patients on Days 3–5 after injury, and in 19 individuals (53%) impairments were found on Days 9–11 after the injury. Nine (25%) of 36 patients exhibited a poor AR response (AR index < 1) on postinjury Days 12–14, which eventually recovered on Days 15–23. Fifty-eight percent of the patients with a Glasgow Coma Scale score of 3–5, 50% of those with diffuse brain injury, 54% of those with elevated intracranial pressure, and 40% of those with poor outcome had no AR recovery in the first 11 days after injury.

Conclusions

Autoregulation recovery after severe TBI can be delayed, and failure to recover during the 2nd week after injury occurs mainly in patients with a lower Glasgow Coma Scale score, diffuse brain injury, elevated ICP, or unfavorable outcome. The finding suggests that perfusion pressure management should be considered in some of the patients for a period of at least 2 weeks.

Abbreviations used in this paper:ANOVA = analysis of variance; AR = autoregulation; BP = blood pressure; CPP = cerebral perfusion pressure; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; MCA = middle cerebral artery; TBI = traumatic brain injury.

Article Information

Address correspondence to: Gill E. Sviri, M.D., M.Sc., Department of Neurosurgery, Rambam (Maimonides) Medical Center, The Technion, Israel Institution of Technology, P.O.B. 31096, Haifa, Israel. email:sviri@u.washington.edu.

Please include this information when citing this paper: published online April 24, 2009; DOI: 10.3171/2008.10.17686.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph showing proportion of patients with impaired AR response (AR index ≥ 1 to < 2.8) and poor AR response (AR index < 1): Period I, within 48 hours from time of injury; Period II, Days 3–5 after the injury; Period III, Days 6–8; Period IV, Days 9–11; Period V, Days 12–14; Period VI, Days 15–18; and Period VII, Days 19–23.

  • View in gallery

    Line graphs demonstrating AR index values (mean ± SEM) over Time Periods I–IV as related to GCS score (A), type of injury (B), ICP (C), and 6-month outcome (D). The probability values were determined with multivariate ANOVA. Period I, within 48 hours of injury; Period II, Days 3–5; Period III, Days 6–8; and Period IV, Days 9–11.

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