Problems with interpretation of transient hyperemic response ratio (THRR)

Sharma, Achyut; Aryal, Diptesh

doi:10.1186/s13089-018-0095-2

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…In 1997, Smielewski et al (24) discovered a correlation between a vanished transient cerebral congestion response rate (THRR) and poor outcomes for patients who had suffered serious craniocerebral injuries. While the value of brain imaging cannot be completely substituted for TCD and THRR index evaluation, they provide a means of continually monitoring cerebrovascular autoregulation in the early stages of treatment for sepsis/septic shock patients (25). Early identification of cerebrovascular autoregulation dysfunction will allow clinical interventions to take place earlier.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Cerebral Hemodynamics, Tissue Oxygen Saturation, and Delirium in Patients With Septic Shock: A Pilot Observational Cohort Study

Feng

Huang

et al. 2021

Front. Med.

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Background: Septic shock patients have tendencies toward impairment in cerebral autoregulation and imbalanced cerebral oxygen metabolism. Tissue Oxygen Saturation (StO2) and Transcranial Doppler (TCD) monitoring were undertaken to observe the variations of cerebral hemodynamic indices and cerebral/peripheral StO2 to find risk factors that increase the sepsis-associated delirium (SAD).Materials and Methods: The research cohort was chosen from septic shock patients received in the Department of Critical Care Medicine, Xiangya Hospital, Central South University between May 2018 and March 2019. These patients were separated into two groups, SAD and non-SAD as assessed by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Comparisons were made between the two groups in terms of peripheral StO2, fluctuations in regional cerebral oxygen saturation (rSO2), cerebral vascular automatic regulation function [Transient Hyperemic Response Ratio (THRR) index], cerebral hemodynamic index, organ function indicators, blood gas analysis indices, and patient characteristics.Results: About 39% of the patients (20/51) suffered from SAD. Nearly 43% of the patients died within 28 days of admission (22/51). Individuals in the SAD cohort needed a longer period of mechanical ventilation [5 (95% CI 2, 6) vs. 1 days (95% CI 1, 4), p = 0.015] and more time in ICU [9 (95% CI 5, 20) vs. 5 days (95% CI 3, 9), p = 0.042]; they also experienced more deaths over the 28-day period (65 vs. 29%, p = 0.011). The multivariate regression analysis indicated that independent variables associated with SAD were THRR index [odds ratio (OR) = 5.770, 95% CI: 1.222–27.255; p = 0.027] and the mean value for rSO2 was < 55% (OR = 3.864, 95% CI: 1.026–14.550; p = 0.046).Conclusion: Independent risk factors for SAD were mean cerebral oxygen saturation below 55% and cerebrovascular dysregulation (THRR < 1.09).

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Section: Discussionmentioning

confidence: 99%

Relationship Between Cerebral Hemodynamics, Tissue Oxygen Saturation, and Delirium in Patients With Septic Shock: A Pilot Observational Cohort Study

Feng

Huang

et al. 2021

Front. Med.

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“…As early as 1997, Smielewski et al [24] found that the disappearance of the transient cerebral congestion response rate (THRR) was associated with poor prognosis in patients with severe craniocerebral injury. Although TCD and THRR index evaluation cannot completely replace the results of brain imaging, they can provide early continuous monitoring of cerebrovascular autoregulation in patients with sepsis and septic shock [25]. The timely detection of the dysfunction of cerebrovascular autoregulation, will improve timely implementation of intervention measures.…”

Section: Discussionmentioning

confidence: 99%

Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

Feng

Huang

et al. 2020

Preprint

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Background Patients with septic shock are prone to have impaired cerebral autoregulation and to have an imbalance in cerebral oxygen metabolism. Transcranial doppler (TCD) and tissue oxygen saturation monitoring were performed to observe the changes in cerebral hemodynamic indices of the middle cerebral artery, and in cerebral and peripheral tissue oxygen saturation (StO 2 ) to identify risk factors for sepsis-associated delirium (SAD). Methods Patients with septic shock that were admitted to the Department of Critical Care Medicine of Xiangya Hospital of Central South University from May 2018 to March 2019 were prospectively enrolled, which were divided into an SAD group and a non-SAD group according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Both groups were compared with respect to patient characteristics, blood gas analysis indexes, organ function indicators, cerebral hemodynamic index, cerebrovascular automatic regulation function (transient hyperemia response rate, THRR index), the changes in regional cerebral oxygen saturation, and peripheral tissue oxygen saturation. Results The incidence of SAD was 39% (20/51). The overall 28-day mortality rate was 43% (22/51). Compared with the non-SAD group, patients in the SAD group required a longer mechanical ventilation time (5 days [95% confidence interval (CI) 2, 6] vs 1day [95% CI 1, 4], p=0.015) and ICU stay (9 days [95% CI 5, 20] vs 5 days [95% CI 3, 9], p=0.042) and has a higher 28-day mortality rate(65% vs 29%, p=0.011).Multivariate regression analysis showed that the THRR index (OR=5.770, 95% CI:1.222-27.255; p=0.027)and mean value of regional cerebral oxygen saturation (rSO 2 ) <55% (OR=3.864, 95% CI:1.026-14.550;p=0.046) were independent risk factors for SAD. Conclusions SAD has a high incidence in septic patients and is associated with poor prognosis. Our results provide a clinical basis for improving early detection and treatment of SAD.

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Problems with interpretation of transient hyperemic response ratio (THRR)

Cited by 2 publications

References 8 publications

Relationship Between Cerebral Hemodynamics, Tissue Oxygen Saturation, and Delirium in Patients With Septic Shock: A Pilot Observational Cohort Study

Relationship Between Cerebral Hemodynamics, Tissue Oxygen Saturation, and Delirium in Patients With Septic Shock: A Pilot Observational Cohort Study

Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational trial

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