How does moderate hypocapnia affect cerebral autoregulation in response to changes in perfusion pressure in TBI patients?

Christina Haubrich, Luzius Steiner, Dong Ju Kim, Magdalena Kasprowicz, Piotr Smielewski, Rolf R. Diehl, John D. Pickard, Marek Czosnyka

Research output: Chapter in Book/Report/Conference proceedingConference contribution

8 Citations (Scopus)

Abstract

In traumatic brain injury, the hypocapnic effects on blood pressure autoregulation may vary from beneficial to detrimental. The consequences of moderate hypocapnia (HC) on the autoregulation of cerebral perfusion pressure (CPP) have not been monitored so far. Thirty head injured patients requiring sedation and mechanical ventilation were studied during normocapnia (5.1 ± 0.4 kPa) and moderate HC (4.4 ± 3.0 kPa). Transcranial Doppler flow velocity (Fv) of the middle cerebral arteries (MCA), invasive arterial blood pressure, and intracranial pressure were monitored. CPP was calculated. The responsiveness of Fv to slow oscillations in CPP was assessed by means of the moving correlation coefficient, the Mx autoregulatory index. Hypocapnic effects on Mx were increasing with its deviation from normal baseline (left MCA: R 2 = 0.67; right MCA: R 2 = 0.51; p < 0.05). Mx indicating normal autoregulation (left:-0.23 ± 0.23; right:-0.21 ± 0.24) was not significantly changed by moderate HC. Impaired Mx autoregulation, however, (left: 0.37 ± 0.13; right: 0.33 ± 0.26) was improved (left: 0.12 ± 0.25; right:-0.0003 ± 0.19; p < 0.01) during moderate HC. Mx was adjusted to normal despite no significant change in CPP levels. Our study showed that short-term moderate HC may optimize the autoregulatory response to spontaneous CPP fluctuations with only a small CPP increase. Patients with impaired autoregulation seemed to benefit the most.

Original languageEnglish
Title of host publicationIntracranial Pressure and Brain Monitoring XIV
PublisherSpringer-Verlag Wien
Pages153-156
Number of pages4
Edition114
ISBN (Print)9783709109557
DOIs
Publication statusPublished - 2012 Jan 1
Externally publishedYes

Publication series

NameActa Neurochirurgica, Supplementum
Number114
ISSN (Print)0065-1419
ISSN (Electronic)0001-6268

Fingerprint

Cerebrovascular Circulation
Hypocapnia
Homeostasis
Perfusion
Pressure
Middle Cerebral Artery
Intracranial Pressure
Artificial Respiration
Arterial Pressure
Head
Blood Pressure

Keywords

  • Cerebral autoregulation
  • Intracranial pressure
  • Moderate hypocapnia
  • Transcranial Doppler
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Haubrich, C., Steiner, L., Kim, D. J., Kasprowicz, M., Smielewski, P., Diehl, R. R., ... Czosnyka, M. (2012). How does moderate hypocapnia affect cerebral autoregulation in response to changes in perfusion pressure in TBI patients? In Intracranial Pressure and Brain Monitoring XIV (114 ed., pp. 153-156). (Acta Neurochirurgica, Supplementum; No. 114). Springer-Verlag Wien. https://doi.org/10.1007/978-3-7091-0956-4_28

How does moderate hypocapnia affect cerebral autoregulation in response to changes in perfusion pressure in TBI patients? / Haubrich, Christina; Steiner, Luzius; Kim, Dong Ju; Kasprowicz, Magdalena; Smielewski, Piotr; Diehl, Rolf R.; Pickard, John D.; Czosnyka, Marek.

Intracranial Pressure and Brain Monitoring XIV. 114. ed. Springer-Verlag Wien, 2012. p. 153-156 (Acta Neurochirurgica, Supplementum; No. 114).

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Haubrich, C, Steiner, L, Kim, DJ, Kasprowicz, M, Smielewski, P, Diehl, RR, Pickard, JD & Czosnyka, M 2012, How does moderate hypocapnia affect cerebral autoregulation in response to changes in perfusion pressure in TBI patients? in Intracranial Pressure and Brain Monitoring XIV. 114 edn, Acta Neurochirurgica, Supplementum, no. 114, Springer-Verlag Wien, pp. 153-156. https://doi.org/10.1007/978-3-7091-0956-4_28
Haubrich C, Steiner L, Kim DJ, Kasprowicz M, Smielewski P, Diehl RR et al. How does moderate hypocapnia affect cerebral autoregulation in response to changes in perfusion pressure in TBI patients? In Intracranial Pressure and Brain Monitoring XIV. 114 ed. Springer-Verlag Wien. 2012. p. 153-156. (Acta Neurochirurgica, Supplementum; 114). https://doi.org/10.1007/978-3-7091-0956-4_28
Haubrich, Christina ; Steiner, Luzius ; Kim, Dong Ju ; Kasprowicz, Magdalena ; Smielewski, Piotr ; Diehl, Rolf R. ; Pickard, John D. ; Czosnyka, Marek. / How does moderate hypocapnia affect cerebral autoregulation in response to changes in perfusion pressure in TBI patients?. Intracranial Pressure and Brain Monitoring XIV. 114. ed. Springer-Verlag Wien, 2012. pp. 153-156 (Acta Neurochirurgica, Supplementum; 114).
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