Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside
Introduction: Continuous monitoring of the pressure reactivity index (PRx) provides an estimation of dynamic cerebral autoregulation (CA) at the bedside in traumatic brain injury (TBI) patients. Visualising the time-trend of PRx with a risk bar chart in ICM + software at the bedside allows for bette...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Brain and Spine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S277252942400016X |
| _version_ | 1797336865210105856 |
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| author | Erta Beqiri Marek Czosnyka Michal M. Placek Giada Cucciolini Virginia Motroni Claudia A. Smith Peter Hutchinson Peter Smielewski |
| author_facet | Erta Beqiri Marek Czosnyka Michal M. Placek Giada Cucciolini Virginia Motroni Claudia A. Smith Peter Hutchinson Peter Smielewski |
| author_sort | Erta Beqiri |
| collection | DOAJ |
| description | Introduction: Continuous monitoring of the pressure reactivity index (PRx) provides an estimation of dynamic cerebral autoregulation (CA) at the bedside in traumatic brain injury (TBI) patients. Visualising the time-trend of PRx with a risk bar chart in ICM + software at the bedside allows for better real-time interpretability of the autoregulation status. When PRx>0.3 is sustained for long periods, typically of at least half an hour, the bar shows a pattern called “red solid line” (RSL). RSL was previously described to precede refractory intracranial hypertension and brain death. Research question: We aimed to describe pathophysiological changes in measured signals/parameters during RSL. Material and methods: Observation of time-trends of PRx, intracranial pressure, cerebral perfusion pressure, brain oxygenation and compensatory reserve of TBI patients with RSL. Results: Three pathophysiological patterns were identified: RSL precedes intracranial hypertension, RSL is preceded by intracranial hypertension, or RSL is preceded by brain hypoperfusion. In all cases, RSL was followed by death and the RSL onset was between 1 h and 1 day before the terminal event. Discussion and conclusion: RSL precedes death in intensive care and could represent a marker for terminal clinical deterioration in TBI patients. These findings warrant further investigations in larger cohorts to characterise pathophysiological mechanisms underlying the RSL pattern and whether RSL has a significant relationship with outcome after TBI. |
| first_indexed | 2024-03-08T09:01:03Z |
| format | Article |
| id | doaj.art-f37f112dc98049f39370ce7a9762a11f |
| institution | Directory Open Access Journal |
| issn | 2772-5294 |
| language | English |
| last_indexed | 2024-03-08T09:01:03Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj.art-f37f112dc98049f39370ce7a9762a11f2024-02-01T06:35:44ZengElsevierBrain and Spine2772-52942024-01-014102760Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedsideErta Beqiri0Marek Czosnyka1Michal M. Placek2Giada Cucciolini3Virginia Motroni4Claudia A. Smith5Peter Hutchinson6Peter Smielewski7Brain Physics Laboratory Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK; Corresponding author.Brain Physics Laboratory Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UKBrain Physics Laboratory Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK; Neurosurgery Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UKBrain Physics Laboratory Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK; Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, ItalyBrain Physics Laboratory Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK; Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, ItalyBrain Physics Laboratory Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UKBrain Physics Laboratory Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UKBrain Physics Laboratory Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UKIntroduction: Continuous monitoring of the pressure reactivity index (PRx) provides an estimation of dynamic cerebral autoregulation (CA) at the bedside in traumatic brain injury (TBI) patients. Visualising the time-trend of PRx with a risk bar chart in ICM + software at the bedside allows for better real-time interpretability of the autoregulation status. When PRx>0.3 is sustained for long periods, typically of at least half an hour, the bar shows a pattern called “red solid line” (RSL). RSL was previously described to precede refractory intracranial hypertension and brain death. Research question: We aimed to describe pathophysiological changes in measured signals/parameters during RSL. Material and methods: Observation of time-trends of PRx, intracranial pressure, cerebral perfusion pressure, brain oxygenation and compensatory reserve of TBI patients with RSL. Results: Three pathophysiological patterns were identified: RSL precedes intracranial hypertension, RSL is preceded by intracranial hypertension, or RSL is preceded by brain hypoperfusion. In all cases, RSL was followed by death and the RSL onset was between 1 h and 1 day before the terminal event. Discussion and conclusion: RSL precedes death in intensive care and could represent a marker for terminal clinical deterioration in TBI patients. These findings warrant further investigations in larger cohorts to characterise pathophysiological mechanisms underlying the RSL pattern and whether RSL has a significant relationship with outcome after TBI.http://www.sciencedirect.com/science/article/pii/S277252942400016XRed solid linePRxlost vascular reactivityIntracranial hypertensionBrain hypoperfusion |
| spellingShingle | Erta Beqiri Marek Czosnyka Michal M. Placek Giada Cucciolini Virginia Motroni Claudia A. Smith Peter Hutchinson Peter Smielewski Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside Brain and Spine Red solid line PRx lost vascular reactivity Intracranial hypertension Brain hypoperfusion |
| title | Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside |
| title_full | Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside |
| title_fullStr | Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside |
| title_full_unstemmed | Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside |
| title_short | Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside |
| title_sort | red solid line patterns of terminal loss of cerebrovascular reactivity at the bedside |
| topic | Red solid line PRx lost vascular reactivity Intracranial hypertension Brain hypoperfusion |
| url | http://www.sciencedirect.com/science/article/pii/S277252942400016X |
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