Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure

Overview

Journal Crit Care Explor

Specialty Critical Care

Date 2024 May 2

PMID 38694846

Authors

Abdulraouf M Z Jijeh

Anis Fatima

Mohammad A Faraji

Hussam K Hamadah

Ghassan A Shaath

Affiliations

Soon will be listed here.

Abstract

Objectives: This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP.

Design: A single-center prospective cohort study.

Setting: The study was conducted in a cardiac center over 4 years (2019-2022).

Patients: Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded.

Interventions: Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24-48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured.

Measurements And Main Results: TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10-16 mm Hg) to 15 mm Hg (IQR, 12-21 mm Hg) postoperatively ( = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14-30 mm Hg) to 28 mm Hg (IQR, 22-38 mm Hg) postoperatively ( = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar.

Conclusions: Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances.

References

Yoshizuka T, Kinoshita M, Iwata S, Tsuda K, Kato T, Saikusa M . Estimation of elevated intracranial pressure in infants with hydroce-phalus by using transcranial Doppler velocimetry with fontanel compression. Sci Rep. 2018; 8(1):11824. PMC: 6081432. DOI: 10.1038/s41598-018-30274-3. View

Robba C, Cardim D, Tajsic T, Pietersen J, Bulman M, Rasulo F . Non-invasive Intracranial Pressure Assessment in Brain Injured Patients Using Ultrasound-Based Methods. Acta Neurochir Suppl. 2018; 126:69-73. DOI: 10.1007/978-3-319-65798-1_15. View

Lahiri S, Schlick K, Padrick M, Rinsky B, Gonzalez N, Jones H . Cerebral Pulsatility Index Is Elevated in Patients with Elevated Right Atrial Pressure. J Neuroimaging. 2017; 28(1):95-98. DOI: 10.1111/jon.12456. View

Simsic J, Bradley S, Mulvihill D . Sodium nitroprusside infusion after bidirectional superior cavopulmonary connection: preserved cerebral blood flow velocity and systemic oxygenation. J Thorac Cardiovasc Surg. 2003; 126(1):186-90. DOI: 10.1016/s0022-5223(03)00582-8. View

Michel E, Zernikow B . Gosling's Doppler pulsatility index revisited. Ultrasound Med Biol. 1998; 24(4):597-9. DOI: 10.1016/s0301-5629(98)00024-6. View

OBrien N, Maa T, Reuter-Rice K . Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury. J Neurosurg Pediatr. 2015; 16(4):420-5. DOI: 10.3171/2015.3.PEDS14521. View

GOSLING R, King D . Arterial assessment by Doppler-shift ultrasound. Proc R Soc Med. 1974; 67(6 Pt 1):447-9. PMC: 1645777. View

OBrien N, Lovett M, Chung M, Maa T . Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury. Childs Nerv Syst. 2020; 36(9):2063-2071. PMC: 7223617. DOI: 10.1007/s00381-020-04524-7. View

Alexandrov A, Sloan M, Wong L, Douville C, Razumovsky A, Koroshetz W . Practice standards for transcranial Doppler ultrasound: part I--test performance. J Neuroimaging. 2007; 17(1):11-8. DOI: 10.1111/j.1552-6569.2006.00088.x. View

10.

Abecasis F, Cardim D, Czosnyka M, Robba C, Agrawal S . Transcranial Doppler as a non-invasive method to estimate cerebral perfusion pressure in children with severe traumatic brain injury. Childs Nerv Syst. 2019; 36(1):125-131. DOI: 10.1007/s00381-019-04273-2. View

11.

Hoskote A, Li J, Hickey C, Erickson S, Van Arsdell G, Stephens D . The effects of carbon dioxide on oxygenation and systemic, cerebral, and pulmonary vascular hemodynamics after the bidirectional superior cavopulmonary anastomosis. J Am Coll Cardiol. 2004; 44(7):1501-9. DOI: 10.1016/j.jacc.2004.06.061. View

12.

Narayan V, Mohammed N, Savardekar A, Patra D, Notarianni C, Nanda A . Noninvasive Intracranial Pressure Monitoring for Severe Traumatic Brain Injury in Children: A Concise Update on Current Methods. World Neurosurg. 2018; 114:293-300. DOI: 10.1016/j.wneu.2018.02.159. View

13.

Edouard A, Vanhille E, Le Moigno S, Benhamou D, Mazoit J . Non-invasive assessment of cerebral perfusion pressure in brain injured patients with moderate intracranial hypertension. Br J Anaesth. 2004; 94(2):216-21. DOI: 10.1093/bja/aei034. View

14.

De Rosa S, Villa G, Franchi P, Mancino A, Tosi F, Martin M . Impact of positive end expiratory pressure on cerebral hemodynamic in paediatric patients with post-traumatic brain swelling treated by surgical decompression. PLoS One. 2018; 13(5):e0196980. PMC: 5944965. DOI: 10.1371/journal.pone.0196980. View

15.

Bertolizio G, DiNardo J, Laussen P, Polito A, Pigula F, Zurakowski D . Evaluation of cerebral oxygenation and perfusion with conversion from an arterial-to-systemic shunt circulation to the bidirectional Glenn circulation in patients with univentricular cardiac abnormalities. J Cardiothorac Vasc Anesth. 2014; 29(1):95-100. DOI: 10.1053/j.jvca.2014.06.001. View

16.

Tegeler C, Crutchfield K, Katsnelson M, Kim J, Tang R, Griffin L . Transcranial Doppler velocities in a large, healthy population. J Neuroimaging. 2012; 23(3):466-72. DOI: 10.1111/j.1552-6569.2012.00711.x. View

17.

Verlhac S . Transcranial Doppler in children. Pediatr Radiol. 2011; 41 Suppl 1:S153-65. DOI: 10.1007/s00247-011-2038-y. View

18.

Kalanuria A, Nyquist P, Armonda R, Razumovsky A . Use of Transcranial Doppler (TCD) ultrasound in the Neurocritical Care Unit. Neurosurg Clin N Am. 2013; 24(3):441-56. DOI: 10.1016/j.nec.2013.02.005. View

19.

Dunn L . Raised intracranial pressure. J Neurol Neurosurg Psychiatry. 2002; 73 Suppl 1:i23-7. PMC: 1765599. DOI: 10.1136/jnnp.73.suppl_1.i23. View

20.

Bellner J, Romner B, Reinstrup P, Kristiansson K, Ryding E, Brandt L . Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol. 2004; 62(1):45-51. DOI: 10.1016/j.surneu.2003.12.007. View