Are Optimal Cerebral Perfusion Pressure and Cerebrovascular Autoregulation Related to Long-term Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage?

Rasulo, Frank; Girardini, Alan; Lavinio, Andrea; Peri, E. De; Stefini, Roberto; Cenzato, Marco; Nodari, Ilaria; Latronico, Nicola

doi:10.1097/ana.0b013e318224030a

Cited by 68 publications

(41 citation statements)

References 27 publications

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“…29 In addition to these pharmacological interventions, managing blood pressure at individually required optimal CPP levels has been suggested as a therapeutic hemodynamic target with the potential to improve both autoregulation and outcome. 18,30 …”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Impaired Cerebrovascular Autoregulation After Severe Aneurysmal Subarachnoid Hemorrhage

Jaeger

Soehle

Schuhmann

et al. 2012

Stroke

127

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Background and Purpose— The purpose of this study was to investigate the relationship between cerebrovascular autoregulation and outcome after aneurysmal subarachnoid hemorrhage. Methods— In a prospective observational study, 80 patients after severe subarachnoid hemorrhage were continuously monitored for cerebral perfusion pressure and partial pressure of brain tissue oxygen for an average of 7.9 days (range, 1.9–14.9 days). Autoregulation was assessed using the index of brain tissue oxygen pressure reactivity (ORx), a moving correlation coefficient between cerebral perfusion pressure and partial pressure of brain tissue oxygen. High ORx indicates impaired autoregulation; low ORx signifies intact autoregulation. Outcome was determined at 6 months and dichotomized into favorable (Glasgow Outcome Scale 4–5) and unfavorable outcome (Glasgow Outcome Scale 1–3). Results— Twenty-four patients had a favorable and 56 an unfavorable outcome. In a univariate analysis, there were significant differences in autoregulation (ORx 0.19±0.10 versus 0.37±0.11, P <0.001, for favorable versus unfavorable outcome, respectively), age (44.1±11.0 years versus 54.2±12.1 years, P =0.001), occurrence of delayed cerebral infarction (8% versus 46%, P <0.001), use of coiling (25% versus 54%, P =0.02), partial pressure of brain tissue oxygen (24.9±6.6 mm Hg versus 21.8±6.3 mm Hg, P =0.048), and Fisher grade ( P =0.03). In a multivariate analysis, ORx ( P <0.001) and age ( P =0.003) retained an independent predictive value for outcome. ORx correlated with Glasgow Outcome Scale ( r =−0.70, P <0.001). Conclusions— The status of cerebrovascular autoregulation might be an important pathophysiological factor in the disease process after subarachnoid hemorrhage, because impaired autoregulation was independently associated with an unfavorable outcome.

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Section: Discussionmentioning

confidence: 99%

Clinical Significance of Impaired Cerebrovascular Autoregulation After Severe Aneurysmal Subarachnoid Hemorrhage

Jaeger

Soehle

Schuhmann

et al. 2012

Stroke

127

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“…It is possible that a subpopulation of patients with acute stroke with relative intact CA may benefit from aggressive blood pressure treatment to improve clinical outcome and decrease harmful side effects. It is also not known if similar to acute stroke, an ‘optimal ABP’ which assures best CA exists and can be assessed using continuous monitoring 30. This critical knowledge gap further supports the need to understand the complex mechanisms of CA on an individual basis and apply to patient care in an era of precision medicine.…”

Section: Clinical Applications Of Ca Studies In Strokementioning

confidence: 99%

Impaired cerebral autoregulation: measurement and application to stroke

Xiong

Liu

Shang

et al. 2017

J Neurol Neurosurg Psychiatry

121

100

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Cerebral autoregulation (CA) is a protective mechanism that maintains cerebral blood flow at a relatively constant level despite fluctuations of cerebral perfusion pressure or arterial blood pressure. It is a universal physiological mechanism that may involve myogenic, neural control as well as metabolic regulations of cerebral vasculature in response to changes in pressure or cerebral blood flow. Traditionally, CA has been represented by a sigmoid curve with a wide plateau between about 50 mm Hg and 170 mm Hg of steady-state changes in mean arterial pressure, defined as static CA. With the advent of transcranial Doppler, measurement of cerebral blood flow in response to transient changes in arterial pressure has been used to assess dynamic CA. However, a gold standard for measuring CA is not currently available. Stroke has been the leading cause of long-term adult disability throughout the world. A better understanding of CA and its response to pathological derangements can help assess the severity of stroke, guide management decisions, assess response to interventions and provide prognostic information. The objective of this review is to provide a comprehensive insight about physiology of autoregulation, measurement methodologies and clinical applications in stroke to help build a consensus for what should be included in an internationally agreed protocol for CA testing and monitoring, and to promote its translation into clinical bedside practice for stroke management.

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“…Some have reported that clotted blood and fluid buildup in the subarachnoid space increase ICP, whereas others have reported that blockage of the normal CSF circulation causes enlargement of the ventricles and elevation of ICP [1,3]. Furthermore, recent studies have shown that cerebral vasospasm following aSAH plays an important role in the elevation of ICP [19][20][21]. However, whether the accumulation of subarachnoid hemorrhage causes an increase in ICP has yet to be determined.…”

Section: Discussionmentioning

confidence: 93%

Relationship between intracranial pressure and aneurysmal subarachnoid hemorrhage grades

Wang¹,

Chen²,

Mao³

et al. 2014

Journal of the Neurological Sciences

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Are Optimal Cerebral Perfusion Pressure and Cerebrovascular Autoregulation Related to Long-term Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage?

Abstract: The assessment of CVA and CPPopt is feasible in aSAH patients and may provide important information regarding long-term outcome. A PRx above the 0.2 threshold and a CPP below the CPPopt range are associated with worse outcome.

Cited by 68 publications

References 27 publications

Clinical Significance of Impaired Cerebrovascular Autoregulation After Severe Aneurysmal Subarachnoid Hemorrhage

Clinical Significance of Impaired Cerebrovascular Autoregulation After Severe Aneurysmal Subarachnoid Hemorrhage

Impaired cerebral autoregulation: measurement and application to stroke

Relationship between intracranial pressure and aneurysmal subarachnoid hemorrhage grades

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