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Hemispheric Differences in Cerebral Autoregulation in Children with Moderate and Severe Traumatic Brain Injury

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Abstract

Introduction

To examine hemispheric differences in cerebral autoregulation in children with traumatic brain injury (TBI). After IRB approval and consent, subjects underwent static cerebral autoregulation testing during the first 9 days after PICU admission. Cerebral autoregulation was quantified using the autoregulatory index (ARI).

Results

Forty-two (27 M:15 F) children (10 ± 5 years) with TBI and admission Glasgow coma scale score (5 ± 2) were enrolled. Seven (54%) of the 13 children with focal TBI and 8 (28%) of 29 children with diffuse TBI had impairment or absence of cerebral autoregulation of atleast one hemisphere. In patients with isolated focal TBI, ARI was lower (0.40 ± 0.40 vs. 0.67 ± 0.40; P = 0.03) in the side of TBI than in the unaffected hemisphere, but cerebral autoregulation was often impaired on the side without TBI or shift (5/13) on head CT. There was no difference in ARI between hemispheres in children with diffuse TBI, with or without superimposed focal lesions (P = 0.17). Patients with bilateral intact cerebral autoregulation tended to have higher 6 month Glasgow Outcome Score (GOS) than patients with either unilateral or bilateral cerebral autoregulation impairment (GOS 4.0 ± 0.60 vs. 3.6 ± 0.80; P = 0.08).

Conclusions

Hemispheric differences in cerebral autoregulation were common in children with isolated focal TBI. Absence of TBI on CT was not always associated with intact cerebral autoregulation. Patients with bilaterally intact cerebral autoregulation tended to have better outcomes.

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Acknowledgements

Thanks to Ms. Domonique Calhoun. This research was supported by National Institute of Child Health and Human Development Award K23HD044632-04.

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Authors and Affiliations

  1. Department of Anesthesiology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359724, Seattle, WA, 98104, USA

    Monica S. Vavilala, Nuj Tontisirin & Yuthana Udomphorn

  2. Department of Pediatrics, Harborview Medical Center, University of Washington, Seattle, WA, USA

    Monica S. Vavilala & Jerry J. Zimmerman

  3. Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA

    Monica S. Vavilala, Randall Chesnut & Arthur M. Lam

  4. Department of Anesthesiology, University of Pennsylvania, Philadelphia, PA, USA

    William Armstead

Authors
  1. Monica S. Vavilala
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  2. Nuj Tontisirin
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  3. Yuthana Udomphorn
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  4. William Armstead
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  5. Jerry J. Zimmerman
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  6. Randall Chesnut
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  7. Arthur M. Lam
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Correspondence to Monica S. Vavilala.

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Vavilala, M.S., Tontisirin, N., Udomphorn, Y. et al. Hemispheric Differences in Cerebral Autoregulation in Children with Moderate and Severe Traumatic Brain Injury. Neurocrit Care 9, 45–54 (2008). https://doi.org/10.1007/s12028-007-9036-9

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  • DOI: https://doi.org/10.1007/s12028-007-9036-9

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