Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study
<i>Introduction</i>: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-06-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/11/7/874 |
| _version_ | 1797528297398075392 |
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| author | Sérgio Brasil Fabio Silvio Taccone Sâmia Yasin Wayhs Bruno Martins Tomazini Filippo Annoni Sérgio Fonseca Estevão Bassi Bruno Lucena Ricardo De Carvalho Nogueira Marcelo De-Lima-Oliveira Edson Bor-Seng-Shu Wellingson Paiva Alexis Fournier Turgeon Manoel Jacobsen Teixeira Luiz Marcelo Sá Malbouisson |
| author_facet | Sérgio Brasil Fabio Silvio Taccone Sâmia Yasin Wayhs Bruno Martins Tomazini Filippo Annoni Sérgio Fonseca Estevão Bassi Bruno Lucena Ricardo De Carvalho Nogueira Marcelo De-Lima-Oliveira Edson Bor-Seng-Shu Wellingson Paiva Alexis Fournier Turgeon Manoel Jacobsen Teixeira Luiz Marcelo Sá Malbouisson |
| author_sort | Sérgio Brasil |
| collection | DOAJ |
| description | <i>Introduction</i>: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. <i>Methods</i>: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). <i>Results</i>: At the first assessment (<i>n</i> = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00–1.28] vs. 1.00 [0.88–1.16]; <i>p</i> = 0.03) and eICP (14 [11–25] vs. 11 [7–15] mmHg; <i>p</i> = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8–12] vs. 6 [5–7]; <i>p</i> < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75–0.97); a score > 8.5 had 63 (46–77)% sensitivity and 87 (62–97)% specificity to predict UO. For those patients undergoing a second assessment (<i>n</i> = 29), after a median of 11 (5–31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (<i>n</i> = 30) and survivors were observed. <i>Conclusions</i>: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome. |
| first_indexed | 2024-03-10T09:56:14Z |
| format | Article |
| id | doaj.art-e3b65cfaca824e8b96381f1664cbd0f2 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-10T09:56:14Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-e3b65cfaca824e8b96381f1664cbd0f22023-11-22T02:21:07ZengMDPI AGBrain Sciences2076-34252021-06-0111787410.3390/brainsci11070874Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot StudySérgio Brasil0Fabio Silvio Taccone1Sâmia Yasin Wayhs2Bruno Martins Tomazini3Filippo Annoni4Sérgio Fonseca5Estevão Bassi6Bruno Lucena7Ricardo De Carvalho Nogueira8Marcelo De-Lima-Oliveira9Edson Bor-Seng-Shu10Wellingson Paiva11Alexis Fournier Turgeon12Manoel Jacobsen Teixeira13Luiz Marcelo Sá Malbouisson14Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, BrazilDepartment of Intensive Care, Universitè Libre de Bruxelles, 1000 Brussels, BelgiumDivision of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, BrazilDepartment of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, BrazilDepartment of Intensive Care, Universitè Libre de Bruxelles, 1000 Brussels, BelgiumDepartment of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, BrazilDepartment of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, BrazilDepartment of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, BrazilDivision of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, BrazilDivision of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, BrazilDivision of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, BrazilDivision of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, BrazilDivision of Critical Care Medicine and the Department of Anesthesiology, Université Laval, Québec City, QC G1V 0A6, CanadaDivision of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, BrazilDepartment of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, Brazil<i>Introduction</i>: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. <i>Methods</i>: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). <i>Results</i>: At the first assessment (<i>n</i> = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00–1.28] vs. 1.00 [0.88–1.16]; <i>p</i> = 0.03) and eICP (14 [11–25] vs. 11 [7–15] mmHg; <i>p</i> = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8–12] vs. 6 [5–7]; <i>p</i> < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75–0.97); a score > 8.5 had 63 (46–77)% sensitivity and 87 (62–97)% specificity to predict UO. For those patients undergoing a second assessment (<i>n</i> = 29), after a median of 11 (5–31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (<i>n</i> = 30) and survivors were observed. <i>Conclusions</i>: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome.https://www.mdpi.com/2076-3425/11/7/874intracranial pressureintracranial compliancecerebrovascular resistancecerebral perfusion pressureCOVID-19 |
| spellingShingle | Sérgio Brasil Fabio Silvio Taccone Sâmia Yasin Wayhs Bruno Martins Tomazini Filippo Annoni Sérgio Fonseca Estevão Bassi Bruno Lucena Ricardo De Carvalho Nogueira Marcelo De-Lima-Oliveira Edson Bor-Seng-Shu Wellingson Paiva Alexis Fournier Turgeon Manoel Jacobsen Teixeira Luiz Marcelo Sá Malbouisson Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study Brain Sciences intracranial pressure intracranial compliance cerebrovascular resistance cerebral perfusion pressure COVID-19 |
| title | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
| title_full | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
| title_fullStr | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
| title_full_unstemmed | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
| title_short | Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study |
| title_sort | cerebral hemodynamics and intracranial compliance impairment in critically ill covid 19 patients a pilot study |
| topic | intracranial pressure intracranial compliance cerebrovascular resistance cerebral perfusion pressure COVID-19 |
| url | https://www.mdpi.com/2076-3425/11/7/874 |
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