How Does Moderate Hypocapnia Affect Cerebral Autoregulation in Response to Changes in Perfusion Pressure in TBI Patients?
In traumatic brain injury, the hypocapnic effects on blood pressure autoregulation may vary from beneficial to detrimental. The consequences of moderate hypocapnia (HC) on the autoregulation of cerebral perfusion pressure (CPP) have not been monitored so far.
Thirty head injured patients requiring sedation and mechanical ventilation were studied during normocapnia (5.1 ± 0.4 kPa) and moderate HC (4.4 ± 3.0 kPa). Transcranial Doppler flow velocity (Fv) of the middle cerebral arteries (MCA), invasive arterial blood pressure, and intracranial pressure were monitored. CPP was calculated. The responsiveness of Fv to slow oscillations in CPP was assessed by means of the moving correlation coefficient, the Mx autoregulatory index. Hypocapnic effects on Mx were increasing with its deviation from normal baseline (left MCA: R 2 = 0.67; right MCA: R 2 = 0.51; p < 0.05). Mx indicating normal autoregulation (left: −0.23 ± 0.23; right: −0.21 ± 0.24) was not significantly changed by moderate HC. Impaired Mx autoregulation, however, (left: 0.37 ± 0.13; right: 0.33 ± 0.26) was improved (left: 0.12 ± 0.25; right: −0.0003 ± 0.19; p < 0.01) during moderate HC. Mx was adjusted to normal despite no significant change in CPP levels. Our study showed that short-term moderate HC may optimize the autoregulatory response to spontaneous CPP fluctuations with only a small CPP increase. Patients with impaired autoregulation seemed to benefit the most.
KeywordsIntracranial pressure Cerebral autoregulation Traumatic brain injury Moderate hypocapnia Transcranial Doppler
The authors are in debt to the whole team participating in data collection and all the nursing and research staff at the Department of Neurosurgery.
Dr. C Haubrich is supported by a Feodor-Lynen scholarship of the Alexander-von-Humboldt Foundation; Dr. M Kasprowicz is a scholar of the Foundation for Polish Science, Dr. M. Czosnyka and Dr. P. Smielewski are supported by MRC grant No.: G9439390, ID 65883. Dr. M. Czosnyka is on unpaid leave from Warsaw University.
Conflict of interest statement
ICM+software (www.neurosurg.cam.ac.uk/icmpluswww.neurosurg,cam,ac.uk/icmplus) is licensed by the University of Cambridge, UK, and P. Smielewski and M. Czosnyka have a financial interest in the licensing fee.