Association between temporal patterns of baroreflex sensitivity after traumatic brain injury and prognosis: a preliminary study

Abstract

Introduction Traumatic brain injury (TBI) may lead to an increase in intracranial pressure (ICP) as well as impairment of cerebral vascular reactivity and the autonomic nervous system. This study aimed to investigate individual patterns of changes in baroreflex sensitivity (BRS) along with the assessment of pressure reactivity index (PRx) and ICP after TBI. Materials and methods Twenty-nine TBI patients with continuous arterial blood pressure (ABP) and ICP monitoring were included. BRS was calculated using the sequential cross-correlation method. PRx was estimated using slow-wave oscillations of ABP and ICP. Outcome was assessed using the Glasgow Outcome Scale. Results Pooled data analysis of the lower breakpoint during the week that followed TBI revealed that BRS reached a minimum about 2 days after TBI. In patients with good outcome, there was a significant increase in BRS during the 7 days following TBI: rp = 0.21; p = 0.008 and the temporal changes in BRS showed either a “U-shaped” pattern or a gradual increase over time. The BRS value after 1.5 days was found to be a significant predictor of mortality (cut-off BRS = 1.8 ms/mm Hg; AUC = 0.83). In patients with poor outcome, ICP and PRx increased while BRS remained low. Conclusions We found an association between temporal patterns of BRS and prognosis in the early days following TBI. Further research in a larger cohort of patients is needed to confirm the weight of these preliminary observations for prediction of prognosis in TBI patients.

Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study

“…Some patients in our study received administration of vasopressors at individually adjusted dosages to regulate ABP. Although, applied pharmaceutical treatment by anesthetics (mainly propofol) and vasopressors can affect both CA and BRS test results by blocking the cardiovascular reflex response [ 40 ] or affecting cerebrovascular reactivity [ 41 , 42 ], however, recent study showed that propofol did not produce a significant alteration in the average heart rate, which serves as the basis for measuring baroreflex sensitivity [ 43 ].…”

Nursing Interventions and Intracranial Pressure Change in Pediatric Patients With Severe Traumatic Brain Injury

“…Using synchronized, predefined changes in blood pressure and heart rate, the multimodal system can continuously monitor the patient's BRS. 22,[32][33][34] With hyperemia and/or ischemia associated with secondary injury and unfavorable outcomes, decreased BRS has also been associated with poor outcomes. 22,32,34 In addition to BRS, HRV can also be monitored with the multimodal system to assess central autonomic regulation, because a TBI can result in autonomic dysfunction.…”

“…22,[32][33][34] With hyperemia and/or ischemia associated with secondary injury and unfavorable outcomes, decreased BRS has also been associated with poor outcomes. 22,32,34 In addition to BRS, HRV can also be monitored with the multimodal system to assess central autonomic regulation, because a TBI can result in autonomic dysfunction. Using the R-to-R pattern of an electrocardiogram, fluctuations between heartbeats are analyzed.…”

“…A TBI can cause baroreflex dysfunction. Using synchronized, predefined changes in blood pressure and heart rate, the multimodal system can continuously monitor the patient's BRS 22,32-34 . With hyperemia and/or ischemia associated with secondary injury and unfavorable outcomes, decreased BRS has also been associated with poor outcomes 22,32,34 .…”

Hypertension at the nexus of veteran status, psychiatric disorders, and traumatic brain injury: Insights from the 2011 Behavioral Risk Factor Surveillance System

“…Meanwhile, TBI, depending on the cerebral location, if the injury was localized to one cerebral location or diffuse across several, and injury severity, can result in axonal injury [81], neurovascular detriments [82], electrophysiological changes [83], and an uncoupling between the cardiovascular and autonomic nervous system [84]. The neuroanatomical disruptions from TBI have been linked to the development of PD [59], anduncoupling of autonomic control over the cardiovascular system can lead to reduced baroreflex sensitivity [85], thereby linking TBI to hypertension. Due to the prevalence of PD among veterans [52][53][54][55]86] and the growth in the number of veterans who have experienced TBI in recent years [57], the presence of PD and/or TBI among veterans appears to be an important factor for hypertension among these individuals.…”