Introduction The autonomic nervous system exerts tonic control on cerebral vessels, which in turn determine the autoregulation of cerebral blood flow. We hypothesize that the impairment of cerebral autoregulation following traumatic brain injury might be related to the acute failure of the autonomic system.
Methods This prospective, observational study included patients with severe traumatic brain injury requiring mechanical ventilation and invasive monitoring of intracra-nial pressure (ICP) and arterial blood pressure (ABP). Pressure reactivity index (PRx), a validated index of cerebrovascular reactivity, was continuously monitored using bedside computers. Autonomic drive was assessed by means of heart rate variability (HRV) using frequency domain analysis.
Findings Eighteen TBI patients were included in the study. Cerebrovascular reactivity impairment (PRx above 0.2) and autonomic failure (low spectral power of HRV) are significantly and independently associated with fatal out-come (P=0.032 and P<0.001, respectively). We observed a significant correlation between PRx and HRV spectral power (P<0.001). The high frequency component of HRV (HF, 0.15–0.4Hz) can be used to predict impaired autor-egulation (PRx>0.2), although sensitivity and specificity are low (ROC AUC=0.67; P=0.001). Conclusion Following traumatic brain injury, autonomic failure and cerebrovascular autoregulation impairment are both associated with fatal outcome. Impairment of cerebro-vascular autoregulation and autonomic drive are interdependent phenomena. With some refinements, HRV might become a tool for screening patients at risk for cerebral autoregulation derangement following TBI.
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References
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354–381
Aegerter P, Boumendil A, Retbi A, Minvielle E, Dervaux B, Guidet B (2005) SAPS II revisited. Intensive Care Med 31:416–423
Asil T, Utku U, Balci K, Uzunca I (2007) Changing cerebral blood flow velocity by transcranial Doppler during head up tilt in patients with diabetes mellitus. Clin Neurol Neurosurg 109:1–6
Balestreri M, Czosnyka M, Steiner LA, Hiler M, Schmidt EA, Matta B, Menon D, Hutchinson P, Pickard JD (2005) Association between outcome, cerebral pressure reactivity and slow ICP waves following head injury. Acta Neurochir Suppl 95:25–28
Cohen JA, Estacio RO, Lundgren RA, Esler AL, Schrier RW (2003) Diabetic autonomic neuropathy is associated with an increased incidence of strokes. Auton Neurosci 108:73–78
Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD (1997) Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery 41:11–17 (discussion 17–19)
Daffertshofer M, Diehl RR, Ziems GU, Hennerici M (1991) Orthostatic changes of cerebral blood flow velocity in patients with autonomic dysfunction. J Neurol Sci 104:32–38
Frokjaer VG, Strauss GI, Mehlsen J, Knudsen GM, Rasmussen V, Larsen FS (2006) Autonomic dysfunction and impaired cerebral autoregulation in cirrhosis. Clin Auton Res 16:208–216
Goldberger AL, Amaral LA, Glass L, Hausdorff JM, Ivanov PC, Mark RG, Mietus JE, Moody GB, Peng CK, Stanley HE (2000) PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation 101:E215–220
Gulbenkian S, Uddman R, Edvinsson L (2001) Neuronal messengers in the human cerebral circulation. Peptides 22:995–1007
Hetzel A, Reinhard M, Guschlbauer B, Braune S (2003) Challenging cerebral autoregulation in patients with preganglionic autonomic failure. Clin Auton Res 13:27–35
Horowitz DR, Kaufmann H (2001) Autoregulatory cerebral vasodilation occurs during orthostatic hypotension in patients with primary autonomic failure. Clin Auton Res 11:363–367
Littell RC, Pendergast J, Natarajan R (2000) Modelling covari-ance structure in the analysis of repeated measures data. Stat Med 19:1793–1819
Ogawa M, Fukuyama H, Harada K, Kimura J (1998) Cerebral blood flow and metabolism in multiple system atrophy of the Shy-Drager syndrome type: a PET study. J Neurol Sci 158:173–179
Smielewski P, Czosnyka M, Steiner L, Belestri M, Piechnik S, Pickard JD (2005) ICM+: software for on-line analysis of bedside monitoring data after severe head trauma. Acta Neurochir Suppl 95:43–49
Steiner LA, Coles JP, Johnston AJ, Chatfield DA, Smielewski P, Fryer TD, Aigbirhio FI, Clark JC, Pickard JD, Menon DK, Czosnyka M (2003) Assessment of cerebrovascular autoregulation in head-injured patients: a validation study. Stroke 34:2404–2409
Winchell RJ, Hoyt DB (1997) Analysis of heart-rate variability: a noninvasive predictor of death and poor outcome in patients with severe head injury. J Trauma 43:927–933
Zhang R, Iwasaki K, Zuckerman JH, Behbehani K, Crandall CG, Levine BD (2002) Mechanism of blood pressure and R—R variability: insights from ganglion blockade in humans. J Physiol 543:337–348
Zhang R, Zuckerman JH, Iwasaki K, Wilson TE, Crandall CG, Levine BD (2002) Autonomic neural control of dynamic cerebral autoregulation in humans. Circulation 106:1814–1820
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Lavinio, A. et al. (2008). Cerebrovascular reactivity and autonomic drive following traumatic brain injury. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_1
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