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Assessment of Cerebrovascular Autoregulation Using Regional Cerebral Blood Flow in Surgically Managed Brain Trauma Patients

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Abstract

Background

Impairment of cerebrovascular autoregulation is a risk factor for ischemic damage following severe brain injury. Autoregulation can be assessed indirectly using intracranial pressure monitoring as a surrogate of cerebral blood volume, but this measure may not be applicable to patients following decompressive craniectomy. Here, we describe assessment of autoregulation using regional cerebral blood flow (rCBF).

Methods

In seven patients with severe brain trauma who underwent neurological surgery, a Hemedex® rCBF probe was placed intraoperatively in peri-lesional tissue. Autoregulation was assessed as a moving Pearson correlation between CPP and rCBF (rCBFx).

Results

Composite data from all patients showed relatively constant perfusion over a wide CPP range (50–90 mmHg) and a U-shaped autoregulation curve with maximal autoregulation (CPPopt) at 55–60 mmHg. All rCBF values fell below the ischemic threshold (<18 ml/100 g/min) when CPPs were <50 mmHg compared with 11 % ischemia when CPPs >50 mmHg (P < 0.05). We examined the percent time during which both autoregulation was intact and rCBF exceeded the ischemic threshold. In the composite data, this variable was maximal in the CPP range of 75–80 mmHg (CPPideal). In individual patients, the range of CPPs with intact autoregulation varied widely. Individual CPPopt values ranged between 60 and 100 mmHg and CPPideal ranged between 65 and 105 mmHg.

Conclusions

Assessment of autoregulation with Hemedex® rCBF monitor is feasible and could be used to guide CPP management strategies to optimize both autoregulation and perfusion. Autoregulatory impairment and CPPopt vary considerably between patients, and the addition of rCBF monitoring could help guide CPP targeting decisions.

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Acknowledgments

This work was funded by the Mayfield Education and Research Foundation and thermal diffusion probes were donated by Hemedex, Inc.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Neurotrauma Center at UC Neuroscience Institute, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA

    Ryan Tackla, Jason M. Hinzman, Mark Magner, Norberto Andaluz & Jed A. Hartings

  2. Mayfield Clinic, Cincinnati, OH, USA

    Ryan Tackla, Mark Magner, Norberto Andaluz & Jed A. Hartings

  3. Department of Neurology and Rehabilitation Medicine, University of Cincinnati (UC) College of Medicine, Neurotrauma Center at UC Neuroscience Institute, Cincinnati, OH, USA

    Brandon Foreman

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  1. Ryan Tackla
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  2. Jason M. Hinzman
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Correspondence to Jason M. Hinzman.

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Tackla, R., Hinzman, J.M., Foreman, B. et al. Assessment of Cerebrovascular Autoregulation Using Regional Cerebral Blood Flow in Surgically Managed Brain Trauma Patients. Neurocrit Care 23, 339–346 (2015). https://doi.org/10.1007/s12028-015-0146-5

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  • DOI: https://doi.org/10.1007/s12028-015-0146-5

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