Cerebrovascular Pressure Reactivity and Cerebral Oxygen Regulation After Severe Head Injury

Overview

Journal Neurocrit Care

Specialty Critical Care

Date 2013 May 25

PMID 23702694

Citations 6

Authors

Matthias Jaeger

Erhard W Lang

Affiliations

Soon will be listed here.

Abstract

Background: To investigate the relationship between cerebrovascular pressure reactivity and cerebral oxygen regulation after head injury.

Methods: Continuous monitoring of the partial pressure of brain tissue oxygen (PbrO2), mean arterial blood pressure (MAP), and intracranial pressure (ICP) in 11 patients. The cerebrovascular pressure reactivity index (PRx) was calculated as the moving correlation coefficient between MAP and ICP. For assessment of the cerebral oxygen regulation system a brain tissue oxygen response (TOR) was calculated, where the response of PbrO2 to an increase of the arterial oxygen through ventilation with 100 % oxygen for 15 min is tested. Arterial blood gas analysis was performed before and after changing ventilator settings.

Results: Arterial oxygen increased from 108 ± 6 mmHg to 494 ± 68 mmHg during ventilation with 100 % oxygen. PbrO2 increased from 28 ± 7 mmHg to 78 ± 29 mmHg, resulting in a mean TOR of 0.48 ± 0.24. Mean PRx was 0.05 ± 0.22. The correlation between PRx and TOR was r = 0.69, P = 0.019. The correlation of PRx and TOR with the Glasgow outcome scale at 6 months was r = 0.47, P = 0.142; and r = -0.33, P = 0.32, respectively.

Conclusions: The results suggest a strong link between cerebrovascular pressure reactivity and the brain's ability to control for its extracellular oxygen content. Their simultaneous impairment indicates that their common actuating element for cerebral blood flow control, the cerebral resistance vessels, are equally impaired in their ability to regulate for MAP fluctuations and changes in brain oxygen.

Citing Articles

Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics (STARSHIP): protocol to study cerebral autoregulation in a prospective multicentre observational research database study.

Agrawal S, Placek M, White D, Daubney E, Cabeleira M, Smielewski P BMJ Open. 2023; 13(3):e071800.

PMID: 36898758 PMC: 10008199. DOI: 10.1136/bmjopen-2023-071800.

Arterial Oxygenation in Traumatic Brain Injury-Relation to Cerebral Energy Metabolism, Autoregulation, and Clinical Outcome.

Svedung Wettervik T, Engquist H, Howells T, Lenell S, Rostami E, Hillered L J Intensive Care Med. 2020; 36(9):1075-1083.

PMID: 32715850 PMC: 8343201. DOI: 10.1177/0885066620944097.

Evaluation of the relationship between slow-waves of intracranial pressure, mean arterial pressure and brain tissue oxygen in TBI: a CENTER-TBI exploratory analysis.

Zeiler F, Cabeleira M, Hutchinson P, Stocchetti N, Czosnyka M, Smielewski P J Clin Monit Comput. 2020; 35(4):711-722.

PMID: 32418148 PMC: 8286934. DOI: 10.1007/s10877-020-00527-6.

Changes in Cerebral Partial Oxygen Pressure and Cerebrovascular Reactivity During Intracranial Pressure Plateau Waves.

Lang E, Kasprowicz M, Smielewski P, Pickard J, Czosnyka M Neurocrit Care. 2014; 23(1):85-91.

PMID: 25501688 DOI: 10.1007/s12028-014-0074-9.

Monitoring of brain and systemic oxygenation in neurocritical care patients.

Oddo M, Bosel J Neurocrit Care. 2014; 21 Suppl 2:S103-20.

PMID: 25208670 DOI: 10.1007/s12028-014-0024-6.

References

Menzel M, Doppenberg E, Zauner A, Soukup J, Reinert M, Bullock R . Increased inspired oxygen concentration as a factor in improved brain tissue oxygenation and tissue lactate levels after severe human head injury. J Neurosurg. 1999; 91(1):1-10. DOI: 10.3171/jns.1999.91.1.0001. View

Johnston A, Steiner L, Gupta A, Menon D . Cerebral oxygen vasoreactivity and cerebral tissue oxygen reactivity. Br J Anaesth. 2003; 90(6):774-86. DOI: 10.1093/bja/aeg104. View

van Santbrink H, vd Brink W, Steyerberg E, Carmona Suazo J, Avezaat C, Maas A . Brain tissue oxygen response in severe traumatic brain injury. Acta Neurochir (Wien). 2003; 145(6):429-38; discussion 438. DOI: 10.1007/s00701-003-0032-3. View

Kiening K, Schneider G, Bardt T, Unterberg A, Lanksch W . Bifrontal measurements of brain tissue-PO2 in comatose patients. Acta Neurochir Suppl. 1998; 71:172-3. DOI: 10.1007/978-3-7091-6475-4_50. View

Jennett B, Bond M . Assessment of outcome after severe brain damage. Lancet. 1975; 1(7905):480-4. DOI: 10.1016/s0140-6736(75)92830-5. View

Czosnyka M, Smielewski P, Kirkpatrick P, Laing R, Menon D, Pickard J . Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery. 1997; 41(1):11-7; discussion 17-9. DOI: 10.1097/00006123-199707000-00005. View

Nakajima S, Meyer J, Amano T, Shaw T, Okabe T, Mortel K . Cerebral vasomotor responsiveness during 100% oxygen inhalation in cerebral ischemia. Arch Neurol. 1983; 40(5):271-6. DOI: 10.1001/archneur.1983.04050050039004. View

Voigt C, Forschler A, Jaeger M, Meixensberger J, Kuppers-Tiedt L, Schuhmann M . Protective effect of hyperbaric oxygen therapy on experimental brain contusions. Acta Neurochir Suppl. 2009; 102:441-5. DOI: 10.1007/978-3-211-85578-2_86. View

Meixensberger J, Dings J, Kuhnigk H, Roosen K . Studies of tissue PO2 in normal and pathological human brain cortex. Acta Neurochir Suppl (Wien). 1993; 59:58-63. DOI: 10.1007/978-3-7091-9302-0_10. View

10.

KETY S, Schmidt C . THE EFFECTS OF ALTERED ARTERIAL TENSIONS OF CARBON DIOXIDE AND OXYGEN ON CEREBRAL BLOOD FLOW AND CEREBRAL OXYGEN CONSUMPTION OF NORMAL YOUNG MEN. J Clin Invest. 1948; 27(4):484-92. PMC: 439519. DOI: 10.1172/JCI101995. View

11.

Omae T, Ibayashi S, Kusuda K, Nakamura H, Yagi H, Fujishima M . Effects of high atmospheric pressure and oxygen on middle cerebral blood flow velocity in humans measured by transcranial Doppler. Stroke. 1998; 29(1):94-7. DOI: 10.1161/01.str.29.1.94. View

12.

Figaji A, Zwane E, Fieggen A, Argent A, Le Roux P, Peter J . The effect of increased inspired fraction of oxygen on brain tissue oxygen tension in children with severe traumatic brain injury. Neurocrit Care. 2010; 12(3):430-7. DOI: 10.1007/s12028-010-9344-3. View

13.

Menzel M, Doppenberg E, Zauner A, Soukup J, Reinert M, Clausen T . Cerebral oxygenation in patients after severe head injury: monitoring and effects of arterial hyperoxia on cerebral blood flow, metabolism and intracranial pressure. J Neurosurg Anesthesiol. 1999; 11(4):240-51. DOI: 10.1097/00008506-199910000-00003. View

14.

Watson N, Beards S, Altaf N, Kassner A, Jackson A . The effect of hyperoxia on cerebral blood flow: a study in healthy volunteers using magnetic resonance phase-contrast angiography. Eur J Anaesthesiol. 2000; 17(3):152-9. DOI: 10.1046/j.1365-2346.2000.00640.x. View

15.

Teasdale G, Jennett B . Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2(7872):81-4. DOI: 10.1016/s0140-6736(74)91639-0. View

16.

Rockswold S, Rockswold G, Zaun D, Liu J . A prospective, randomized Phase II clinical trial to evaluate the effect of combined hyperbaric and normobaric hyperoxia on cerebral metabolism, intracranial pressure, oxygen toxicity, and clinical outcome in severe traumatic brain injury. J Neurosurg. 2013; 118(6):1317-28. DOI: 10.3171/2013.2.JNS121468. View

17.

Hlatky R, Valadka A, Gopinath S, Robertson C . Brain tissue oxygen tension response to induced hyperoxia reduced in hypoperfused brain. J Neurosurg. 2008; 108(1):53-8. DOI: 10.3171/JNS/2008/108/01/0053. View