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Monitoring cerebrovascular reactivity in pediatric traumatic brain injury: comparison of three methods

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Abstract

Purpose

To study three different methods of monitoring cerebral autoregulation in children with severe traumatic brain injury.

Methods

Prospective cohort study of all children admitted to the pediatric intensive care unit at a university-affiliated hospital with severe TBI over a 4-year period to study three different methods of monitoring cerebral autoregulation: pressure-reactivity index (PRx), transcranial Doppler derived mean flow velocity index (Mx), and near-infrared spectroscopy derived cerebral oximetry index (COx).

Results

Twelve patients were included in the study, aged 5 months to 17 years old. An empirical regression analyzing dependence of PRx on cerebral perfusion pressure (CPP) displayed the classic U-shaped distribution, with low PRx values (< 0.3) reflecting intact auto-regulation, within the CPP range of 50–100 mmHg. The optimal CPP was 75–80 mmHg for PRx and COx. The correlation coefficients between the three indices were as follows: PRx vs Mx, r = 0.56; p < 0.0001; PRx vs COx, r = 0.16; p < 0.0001; and COx vs Mx, r = 0.15; p = 0.022. The mean PRx with a cutoff value of 0.3 predicted correctly long-term outcome (p = 0.015).

Conclusions

PRx seems to be the most robust index to access cerebrovascular reactivity in children with TBI and has promising prognostic value. Optimal CPP calculation is feasible with PRx and COx.

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Data is available if necessary.

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Funding

MC is supported by NIHR Biomedical Research Centre, Cambridge.

Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, Faculdade de Medicina, Centro Hospitalar Universitário Lisboa Norte, Universidade de Lisboa, Lisbon, Portugal

    Francisco Abecasis

  2. Intensive Care Department, Neurocritical Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal

    Celeste Dias

  3. Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK

    Agnieszka Zakrzewska & Marek Czosnyka

  4. Laboratory of Cerebral Ultrasound, Neurology Department, Faculdade de Medicina, Centro Hospitalar Universitário Lisboa Norte, Universidade de Lisboa, Lisbon, Portugal

    Vitor Oliveira

  5. Institute of Electronic Systems, Warsaw University of Technology, Warszawa, Poland

    Marek Czosnyka

Authors
  1. Francisco Abecasis
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  2. Celeste Dias
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  3. Agnieszka Zakrzewska
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  4. Vitor Oliveira
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  5. Marek Czosnyka
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Corresponding author

Correspondence to Francisco Abecasis.

Ethics declarations

Ethics approval

The Institutional Review Board and Ethical Committee of the Lisbon Academic Medical Centre have approved this study. All performed procedures were part of the standard care for severe TBI in the PICU.

Consent to participate

Informed consent was obtained from parents or next of kin at the time of admission and from the children older than 14 years old when they recovered if they were able to understand and give consent.

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Consent for publication was included in the consent to participate form.

Conflict of interest

MC has a financial interest in a part of ICM + software licensing fee.

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Abecasis, F., Dias, C., Zakrzewska, A. et al. Monitoring cerebrovascular reactivity in pediatric traumatic brain injury: comparison of three methods. Childs Nerv Syst 37, 3057–3065 (2021). https://doi.org/10.1007/s00381-021-05263-z

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  • DOI: https://doi.org/10.1007/s00381-021-05263-z

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