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Cerebral physiologic insult burden in acute traumatic neural injury: a Canadian High Resolution-TBI (CAHR-TBI) descriptive analysis.
Stein, Kevin Y; Gomez, Alwyn; Griesdale, Donald; Sekhon, Mypinder; Bernard, Francis; Gallagher, Clare; Thelin, Eric P; Raj, Rahul; Aries, Marcel; Froese, Logan; Kramer, Andreas; Zeiler, Frederick A.
Afiliación
  • Stein KY; Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada. steink34@myumanitoba.ca.
  • Gomez A; Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. steink34@myumanitoba.ca.
  • Griesdale D; Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
  • Sekhon M; Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
  • Bernard F; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
  • Gallagher C; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
  • Thelin EP; Division of Critical Care, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
  • Raj R; Section of Critical Care, Department of Medicine, University of Montreal, Montreal, QC, Canada.
  • Aries M; Section of Neurosurgery, University of Calgary, Calgary, AB, Canada.
  • Froese L; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
  • Kramer A; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
  • Zeiler FA; Medical Unit Neurology, Karolinska University Hospital, Stockholm, Sweden.
Crit Care ; 28(1): 294, 2024 Sep 04.
Article en En | MEDLINE | ID: mdl-39232842
ABSTRACT

BACKGROUND:

Over the recent decades, continuous multi-modal monitoring of cerebral physiology has gained increasing interest for its potential to help minimize secondary brain injury following moderate-to-severe acute traumatic neural injury (also termed traumatic brain injury; TBI). Despite this heightened interest, there has yet to be a comprehensive evaluation of the effects of derangements in multimodal cerebral physiology on global cerebral physiologic insult burden. In this study, we offer a multi-center descriptive analysis of the associations between deranged cerebral physiology and cerebral physiologic insult burden.

METHODS:

Using data from the Canadian High-Resolution TBI (CAHR-TBI) Research Collaborative, a total of 369 complete patient datasets were acquired for the purposes of this study. For various cerebral physiologic metrics, patients were trichotomized into low, intermediate, and high cohorts based on mean values. Jonckheere-Terpstra testing was then used to assess for directional relationships between these cerebral physiologic metrics and various measures of cerebral physiologic insult burden. Contour plots were then created to illustrate the impact of preserved vs impaired cerebrovascular reactivity on these relationships.

RESULTS:

It was found that elevated intracranial pressure (ICP) was associated with more time spent with cerebral perfusion pressure (CPP) < 60 mmHg and more time with impaired cerebrovascular reactivity. Low CPP was associated with more time spent with ICP > 20 or 22 mmHg and more time spent with impaired cerebrovascular reactivity. Elevated cerebrovascular reactivity indices were associated with more time spent with CPP < 60 mmHg as well as ICP > 20 or 22 mmHg. Low brain tissue oxygenation (PbtO2) only demonstrated a significant association with more time spent with CPP < 60 mmHg. Low regional oxygen saturation (rSO2) failed to produce a statistically significant association with any particular measure of cerebral physiologic insult burden.

CONCLUSIONS:

Mean ICP, CPP and, cerebrovascular reactivity values demonstrate statistically significant associations with global cerebral physiologic insult burden; however, it is uncertain whether measures of oxygen delivery provide any significant insight into such insult burden.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Lesiones Traumáticas del Encéfalo Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Crit Care Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Lesiones Traumáticas del Encéfalo Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Crit Care Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido