Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort study
Abstract Background Brain tissue oxygen tension (PbtO2) and cerebrovascular pressure reactivity monitoring have emerged as potential modalities to individualize care in moderate and severe traumatic brain injury (TBI). The relationship between these modalities has had limited exploration. The aim of...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-12-01
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| Series: | Intensive Care Medicine Experimental |
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| Online Access: | https://doi.org/10.1186/s40635-022-00482-3 |
| _version_ | 1797977627704688640 |
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| author | Alwyn Gomez Mypinder Sekhon Donald Griesdale Logan Froese Eleen Yang Eric P. Thelin Rahul Raj Marcel Aries Clare Gallagher Francis Bernard Andreas H. Kramer Frederick A. Zeiler |
| author_facet | Alwyn Gomez Mypinder Sekhon Donald Griesdale Logan Froese Eleen Yang Eric P. Thelin Rahul Raj Marcel Aries Clare Gallagher Francis Bernard Andreas H. Kramer Frederick A. Zeiler |
| author_sort | Alwyn Gomez |
| collection | DOAJ |
| description | Abstract Background Brain tissue oxygen tension (PbtO2) and cerebrovascular pressure reactivity monitoring have emerged as potential modalities to individualize care in moderate and severe traumatic brain injury (TBI). The relationship between these modalities has had limited exploration. The aim of this study was to examine the relationship between PbtO2 and cerebral perfusion pressure (CPP) and how this relationship is modified by the state of cerebrovascular pressure reactivity. Methods A retrospective multi-institution cohort study utilizing prospectively collected high-resolution physiologic data from the CAnadian High Resolution-TBI (CAHR-TBI) Research Collaborative database collected between 2011 and 2021 was performed. Included in the study were critically ill TBI patients with intracranial pressure (ICP), arterial blood pressure (ABP), and PbtO2 monitoring treated in any one of three CAHR-TBI affiliated adult intensive care units (ICU). The outcome of interest was how PbtO2 and CPP are related over a cohort of TBI patients and how this relationship is modified by the state of cerebrovascular reactivity, as determined using the pressure reactivity index (PRx). Results A total of 77 patients met the study inclusion criteria with a total of 377,744 min of physiologic data available for the analysis. PbtO2 produced a triphasic curve when plotted against CPP like previous population-based plots of cerebral blood flow (CBF) versus CPP. The triphasic curve included a plateau region flanked by regions of relative ischemia (hypoxia) and hyperemia (hyperoxia). The plateau region shortened when cerebrovascular pressure reactivity was disrupted compared to when it was intact. Conclusions In this exploratory analysis of a multi-institution high-resolution physiology TBI database, PbtO2 seems to have a triphasic relationship with CPP, over the entire cohort. The CPP range over which the plateau exists is modified by the state of cerebrovascular reactivity. This indicates that in critically ill TBI patients admitted to ICU, PbtO2 may be reflective of CBF. |
| first_indexed | 2024-04-11T05:09:31Z |
| format | Article |
| id | doaj.art-47254338137f4790b4d4205d862b8af4 |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-04-11T05:09:31Z |
| publishDate | 2022-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-47254338137f4790b4d4205d862b8af42022-12-25T12:02:42ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2022-12-0110111410.1186/s40635-022-00482-3Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort studyAlwyn Gomez0Mypinder Sekhon1Donald Griesdale2Logan Froese3Eleen Yang4Eric P. Thelin5Rahul Raj6Marcel Aries7Clare Gallagher8Francis Bernard9Andreas H. Kramer10Frederick A. Zeiler11Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of ManitobaDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British ColumbiaDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British ColumbiaBiomedical Engineering, Faculty of Engineering, University of ManitobaDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British ColumbiaDepartment of Neurology, Karolinska University HospitalDepartment of Neurosurgery, University of Helsinki and Helsinki University HospitalDepartment of Intensive Care, Maastricht University Medical CenterSection of Neurosurgery, Department of Clinical Neurosciences, University of CalgarySection of Critical Care, Department of Medicine, University of MontrealDepartment of Critical Care Medicine, University of CalgaryDepartment of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of ManitobaAbstract Background Brain tissue oxygen tension (PbtO2) and cerebrovascular pressure reactivity monitoring have emerged as potential modalities to individualize care in moderate and severe traumatic brain injury (TBI). The relationship between these modalities has had limited exploration. The aim of this study was to examine the relationship between PbtO2 and cerebral perfusion pressure (CPP) and how this relationship is modified by the state of cerebrovascular pressure reactivity. Methods A retrospective multi-institution cohort study utilizing prospectively collected high-resolution physiologic data from the CAnadian High Resolution-TBI (CAHR-TBI) Research Collaborative database collected between 2011 and 2021 was performed. Included in the study were critically ill TBI patients with intracranial pressure (ICP), arterial blood pressure (ABP), and PbtO2 monitoring treated in any one of three CAHR-TBI affiliated adult intensive care units (ICU). The outcome of interest was how PbtO2 and CPP are related over a cohort of TBI patients and how this relationship is modified by the state of cerebrovascular reactivity, as determined using the pressure reactivity index (PRx). Results A total of 77 patients met the study inclusion criteria with a total of 377,744 min of physiologic data available for the analysis. PbtO2 produced a triphasic curve when plotted against CPP like previous population-based plots of cerebral blood flow (CBF) versus CPP. The triphasic curve included a plateau region flanked by regions of relative ischemia (hypoxia) and hyperemia (hyperoxia). The plateau region shortened when cerebrovascular pressure reactivity was disrupted compared to when it was intact. Conclusions In this exploratory analysis of a multi-institution high-resolution physiology TBI database, PbtO2 seems to have a triphasic relationship with CPP, over the entire cohort. The CPP range over which the plateau exists is modified by the state of cerebrovascular reactivity. This indicates that in critically ill TBI patients admitted to ICU, PbtO2 may be reflective of CBF.https://doi.org/10.1186/s40635-022-00482-3Traumatic brain injuryBrain tissue oxygen tensionCerebrovascular reactivityMulti-modal monitoringCerebrovascular physiology |
| spellingShingle | Alwyn Gomez Mypinder Sekhon Donald Griesdale Logan Froese Eleen Yang Eric P. Thelin Rahul Raj Marcel Aries Clare Gallagher Francis Bernard Andreas H. Kramer Frederick A. Zeiler Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort study Intensive Care Medicine Experimental Traumatic brain injury Brain tissue oxygen tension Cerebrovascular reactivity Multi-modal monitoring Cerebrovascular physiology |
| title | Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort study |
| title_full | Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort study |
| title_fullStr | Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort study |
| title_full_unstemmed | Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort study |
| title_short | Cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury: a CAnadian High Resolution-TBI (CAHR-TBI) cohort study |
| title_sort | cerebrovascular pressure reactivity and brain tissue oxygen monitoring provide complementary information regarding the lower and upper limits of cerebral blood flow control in traumatic brain injury a canadian high resolution tbi cahr tbi cohort study |
| topic | Traumatic brain injury Brain tissue oxygen tension Cerebrovascular reactivity Multi-modal monitoring Cerebrovascular physiology |
| url | https://doi.org/10.1186/s40635-022-00482-3 |
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