Dynamic cerebral autoregulation: A marker of post-operative delirium?

Caldas, Juliana; Panerai, Ronney B.; Bor‐Seng‐Shu, Edson; Ferreira, Gerson Moura; Câmara, Lígia; Passos, Rogério Hora; Oliveira, Marcelo de Lima; Galas, Filomena Regina Barbosa Gomes; Almeida, Juliano Pinheiro de; Nogueira, Ricardo C.; Mian, N.; Gaiotto, Fábio Antônio; Robinson, Thompson G.; Hajjar, Ludhmila Abrahão

doi:10.1016/j.clinph.2018.11.008

Cited by 23 publications

(27 citation statements)

References 48 publications

(56 reference statements)

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“…The evaluation of dynamic CA in an ICU setting has been previously reported. 8 This case corroborates previous reports of the many benefits of having TCD available in the ICU as an easy-to-use, safe, and lowcost bedside tool. 11,12 This tool allowed us not only to observe changes in CBFV but also monitor CA at the bedside.…”

Section: Discussionsupporting

confidence: 90%

“…The value of ARI ¼ 3.9 in this patient suggests impaired CA, considering that healthy individuals have values around 6 AE 1. 6,8 The value of CA assessment in acute ICH is found in the ability to evaluate the dynamic impact of blood pressure lowering therapies on cerebral perfusion, to detect situations where the brain is at risk of hypo-or hyperperfusion, and to establish associations with clinical outcome. This is crucial as randomised controlled trials to date have failed to clarify whether intensive versus standard blood pressure lowering is indeed a viable intervention for ICH patients with large haematoma volume requiring ITU admission.…”

Section: Discussionmentioning

confidence: 99%

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Intensive care management of arterial carbon dioxide in acute intracerebral haemorrhage: Case report of influences on cerebral haemodynamics

et al. 2020

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Intracerebral haemorrhage is relatively common and has devastating consequences. Furthermore, non-invasive and invasive strategies to manage raised intracranial pressure remain limited and associated with high morbidity and mortality. We report a case of a 72-year-old male with intracerebral haemorrhage with ventricular extension, hydrocephalus and intracranial hypertension, who was evaluated by transcranial Doppler ultrasound and optic nerve sheath diameter. This case demonstrates that beyond pharmacological and surgical interventions, simple manipulation of arterial carbon dioxide has the propensity to improve cerebral haemodynamic parameters. Our results demonstrate the negative effects of hypercapnia on cerebral autoregulation and the benefits of having transcranial Doppler ultrasound available in the intensive care unit point of care.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Intensive care management of arterial carbon dioxide in acute intracerebral haemorrhage: Case report of influences on cerebral haemodynamics

et al. 2020

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“…Impaired CA was found in 55% of patients 24 h postoperatively and in 20% after 7 days. In addition, the authors concluded that impaired CA during coronary artery bypass graft (CABG) surgery is a significant independent risk factor for PD ( p = 0.003) ( 22 ). Another study analyzed the use of CA with NIRS.…”

Section: Resultsmentioning

confidence: 99%

“…Important consequences of impaired CA were also found in the PO period. The studies included were mainly conducted in the context of cardiac surgery, in particular during cardiopulmonary bypass in which the cause of PD must be sought together with other risk factors ( 22 , 24 , 25 ). In support of this theory, an increased level of neuronal biomarkers was found in the serum of patients with impaired CA in the PO period, but further studies are needed to fully understand the association between POCD and altered brain flow as a consequence of the loss of CA ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review

et al. 2021

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Introduction: Cerebral autoregulation (CA) plays a fundamental role in the maintenance of adequate cerebral blood flow (CBF). CA monitoring, through direct and indirect techniques, may guide an appropriate therapeutic approach aimed at improving CBF and reducing neurological complications; so far, the role of CA has been investigated mainly in brain-injured patients. The aim of this study is to investigate the role of CA in non-brain injured patients.Methods: A systematic consultation of literature was carried out. Search terms included: “CA and sepsis,” “CA and surgery,” and “CA and non-brain injury.”Results: Our research individualized 294 studies and after screening, 22 studies were analyzed in this study. Studies were divided in three groups: CA in sepsis and septic shock, CA during surgery, and CA in the pediatric population. Studies in sepsis and intraoperative setting highlighted a relationship between the incidence of sepsis-associated delirium and impaired CA. The most investigated setting in the pediatric population is cardiac surgery, but the role and measurement of CA need to be further elucidated.Conclusion: In non-brain injured patients, impaired CA may result in cognitive dysfunction, neurological damage, worst outcome, and increased mortality. Monitoring CA might be a useful tool for the bedside optimization and individualization of the clinical management in this group of patients.

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“…All healthy controls selected from the database had ARI ≥ 5 taking into account that normal average ARI = 5 (Tiecks et al, 1995;Deegan et al, 2010;Subudhi et al, 2015). In patients, values of ARI≤4 were adopted as the criterion for impaired dCA (Patel et al, 2016;Caldas et al, 2017;Caldas et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Can we use short recordings for assessment of dynamic cerebral autoregulation? A sensitivity analysis study in acute ischaemic stroke and healthy subjects

Intharakham¹,

Panerai²,

Katsogridakis³

et al. 2019

Physiol. Meas.

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Objective: It is unclear whether the duration of recordings influences estimates of dynamic cerebral autoregulation (dCA). Therefore, we performed a retrospective study of the effects of reducing recording durations on dCA estimates; with the potential to inform recording duration for reliable estimates in challenging clinical populations. Approach: Seventy-eight healthy control subjects and 79 acute ischaemic stroke (AIS) patients were included. Cerebral blood flow velocity was recorded with transcranial Doppler and continuous blood pressure with the Finapres device. The autoregulation index (ARI), derived with transfer function analysis, was calculated for recording durations at one-minute intervals between 1 and 5 minutes using the same starting point of each recording. Main results: Though recording duration did not affect the overall ARI value, when compared to control subjects, AIS patients had significantly lower ARI values for durations between 3 and 5 (p<0.0001), but not 1 and 2 minutes. The intraclass correlation coefficient of all participants, for reproducibility of the five recording durations, was 0.69. AIS patients classified as having impaired cerebral autoregulation (CA; ARI≤4) at 5 min, had a 7.1% rate of false negatives for both 4 and 3 min recordings, reaching 42.9% for 1 min recording. The percentage of false-positives also increased with reduced recording durations (from 0% at 5 to 16.2% at 1 minute). Significance: Reducing recording durations from 5 to 3 min can still provide reliable estimates of ARI, and may facilitate CA studies in potentially medically unstable AIS patients, as well as in other patient groups.

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Dynamic cerebral autoregulation: A marker of post-operative delirium?

Cited by 23 publications

References 48 publications

Intensive care management of arterial carbon dioxide in acute intracerebral haemorrhage: Case report of influences on cerebral haemodynamics

Intensive care management of arterial carbon dioxide in acute intracerebral haemorrhage: Case report of influences on cerebral haemodynamics

Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review

Can we use short recordings for assessment of dynamic cerebral autoregulation? A sensitivity analysis study in acute ischaemic stroke and healthy subjects

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