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Serial Measurement of Static and Dynamic Cerebrovascular Autoregulation After Brain Injury

Schramm, Patrick MD*; Klein, Klaus Ulrich MD*; Pape, Monika MD*; Berres, Manfred PhD; Werner, Christian MD, PhD*; Kochs, Eberhard MD, PhD; Engelhard, Kristin MD, PhD*

Journal of Neurosurgical Anesthesiology: January 2011 - Volume 23 - Issue 1 - p 41–44
doi: 10.1097/ANA.0b013e3181f35854
Clinical Report
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Background In patients with neuronal injury, the knowledge of the status of cerebrovascular autoregulation can help to optimize the management of the cerebral perfusion pressure. This study characterizes dynamic and static cerebrovascular autoregulation during the first 7 days after severe traumatic brain injury or intracranial hemorrhage.

Methods After approval from the IRB, 16 patients were studied. Cerebral blood flow velocity (CBFV) was measured daily for the assessment of dynamic (10 patients) and static (16 patients) cerebrovascular autoregulation in both the middle cerebral arteries using the transcranial Doppler sonography. Dynamic cerebrovascular autoregulation (dAR) was measured using the cuff-deflation method and was expressed by the index of the dAR. The index of the static cerebrovascular autoregulation (sAR) was calculated from changes in the CBFV in relation to drug-induced alterations of the arterial blood pressure. For statistical analyses, t test and mixed effect model were used.

Results Both dAR and sAR after brain injury were impaired in most of the patients. The chronologic sequence of the dAR at the ipsilateral injured hemisphere showed a significant decrease until day 4 followed by an incomplete recovery (P<0.002). Changes in sAR were similar, however, they did not gain statistical significance. CBFV was lower at day 1-2 after injury in comparison with day 4 to 7 (P<0.02).

Conclusion Daily measured dAR and sAR were impaired after brain injury with a nadir on day 4 and consecutive incomplete recovery over time.

*Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University Mainz

Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, and RheinAhrCampus Remagen

Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Germany

Reprints: Dr Patrick Schramm, MD, Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany (e-mail: schrammp@uni-mainz.de).

Received March 18, 2010

Accepted July 22, 2010

© 2011 Lippincott Williams & Wilkins, Inc.