Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study
Abstract Background Subarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage C...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-04-01
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| Series: | The Ultrasound Journal |
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| Online Access: | https://doi.org/10.1186/s13089-024-00371-8 |
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| author | Edvinas Chaleckas Vilma Putnynaite Indre Lapinskiene Aidanas Preiksaitis Mindaugas Serpytis Saulius Rocka Laimonas Bartusis Vytautas Petkus Arminas Ragauskas |
| author_facet | Edvinas Chaleckas Vilma Putnynaite Indre Lapinskiene Aidanas Preiksaitis Mindaugas Serpytis Saulius Rocka Laimonas Bartusis Vytautas Petkus Arminas Ragauskas |
| author_sort | Edvinas Chaleckas |
| collection | DOAJ |
| description | Abstract Background Subarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage CA impairments and SAH patient outcomes. The objective of this prospective study was to explore associations between CA impairments detected in early post-SAH snapshot examinations and patient outcomes. Methods The pilot observational study included 29 SAH patients whose CA status was estimated 2–3 days after spontaneous aneurysm rupture and a control group of 15 healthy volunteers for comparison. Inflatable leg recovery boots (reboots.com, Germany) were used for the safe controlled generation of arterial blood pressure (ABP) changes necessary for reliable CA examination. At least 5 inflation‒deflation cycles of leg recovery boots with a 2–3 min period were used during examinations. CA status was assessed according to the delay time (∆TCBFV) measured between ABP(t) and cerebral blood flow velocity (CBFV(t)) signals during artificially induced ABP changes at boot deflation cycle. CBFV was measured in middle cerebral artery by using transcranial Doppler device. Results Statistically significant differences in ∆TCBFV were found between SAH patients with unfavorable outcomes (∆TCBFV = 1.37 ± 1.23 s) and those with favorable outcomes (∆TCBFV = 2.86 ± 0.99 s) (p < 0.001). Early assessment of baroreflex sensitivity (BRS) during the deflation cycle showed statistically significant differences between the DCI and non-DCI patient groups (p = 0.039). Conclusions A relatively small delay of ∆TCBFV <1.6 s between CBFV(t) and ABP(t) waves could be an early warning sign associated with unfavorable outcomes in SAH patients. The BRS during boot deflation can be used as a biomarker for the prediction of DCI. Trial registration ClinicalTrials.gov Identifier: NCT06028906. Registered 31 August 2023 - Retrospectively registered, https://www.clinicaltrials.gov/study/NCT06028906 . |
| first_indexed | 2024-04-24T07:17:27Z |
| format | Article |
| id | doaj.art-6d6b14e5f77c4380bb197ae6649b17d0 |
| institution | Directory Open Access Journal |
| issn | 2524-8987 |
| language | English |
| last_indexed | 2024-04-24T07:17:27Z |
| publishDate | 2024-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Ultrasound Journal |
| spelling | doaj.art-6d6b14e5f77c4380bb197ae6649b17d02024-04-21T11:12:56ZengSpringerOpenThe Ultrasound Journal2524-89872024-04-0116111210.1186/s13089-024-00371-8Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot studyEdvinas Chaleckas0Vilma Putnynaite1Indre Lapinskiene2Aidanas Preiksaitis3Mindaugas Serpytis4Saulius Rocka5Laimonas Bartusis6Vytautas Petkus7Arminas Ragauskas8Health Telematics Science Institute, Kaunas University of TechnologyHealth Telematics Science Institute, Kaunas University of TechnologyClinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius UniversityClinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius UniversityClinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius UniversityClinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius UniversityHealth Telematics Science Institute, Kaunas University of TechnologyHealth Telematics Science Institute, Kaunas University of TechnologyHealth Telematics Science Institute, Kaunas University of TechnologyAbstract Background Subarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage CA impairments and SAH patient outcomes. The objective of this prospective study was to explore associations between CA impairments detected in early post-SAH snapshot examinations and patient outcomes. Methods The pilot observational study included 29 SAH patients whose CA status was estimated 2–3 days after spontaneous aneurysm rupture and a control group of 15 healthy volunteers for comparison. Inflatable leg recovery boots (reboots.com, Germany) were used for the safe controlled generation of arterial blood pressure (ABP) changes necessary for reliable CA examination. At least 5 inflation‒deflation cycles of leg recovery boots with a 2–3 min period were used during examinations. CA status was assessed according to the delay time (∆TCBFV) measured between ABP(t) and cerebral blood flow velocity (CBFV(t)) signals during artificially induced ABP changes at boot deflation cycle. CBFV was measured in middle cerebral artery by using transcranial Doppler device. Results Statistically significant differences in ∆TCBFV were found between SAH patients with unfavorable outcomes (∆TCBFV = 1.37 ± 1.23 s) and those with favorable outcomes (∆TCBFV = 2.86 ± 0.99 s) (p < 0.001). Early assessment of baroreflex sensitivity (BRS) during the deflation cycle showed statistically significant differences between the DCI and non-DCI patient groups (p = 0.039). Conclusions A relatively small delay of ∆TCBFV <1.6 s between CBFV(t) and ABP(t) waves could be an early warning sign associated with unfavorable outcomes in SAH patients. The BRS during boot deflation can be used as a biomarker for the prediction of DCI. Trial registration ClinicalTrials.gov Identifier: NCT06028906. Registered 31 August 2023 - Retrospectively registered, https://www.clinicaltrials.gov/study/NCT06028906 .https://doi.org/10.1186/s13089-024-00371-8Subarachnoid hemorrhageDelayed cerebral ischemiaCerebral blood flow autoregulationBaroreflexSnapshot examinationTranscranial Doppler |
| spellingShingle | Edvinas Chaleckas Vilma Putnynaite Indre Lapinskiene Aidanas Preiksaitis Mindaugas Serpytis Saulius Rocka Laimonas Bartusis Vytautas Petkus Arminas Ragauskas Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study The Ultrasound Journal Subarachnoid hemorrhage Delayed cerebral ischemia Cerebral blood flow autoregulation Baroreflex Snapshot examination Transcranial Doppler |
| title | Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study |
| title_full | Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study |
| title_fullStr | Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study |
| title_full_unstemmed | Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study |
| title_short | Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study |
| title_sort | impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage an observational prospective pilot study |
| topic | Subarachnoid hemorrhage Delayed cerebral ischemia Cerebral blood flow autoregulation Baroreflex Snapshot examination Transcranial Doppler |
| url | https://doi.org/10.1186/s13089-024-00371-8 |
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