@article{ref1,
title="Systemic markers of injury and injury response are not associated with impaired cerebrovascular reactivity in adult TBI: a CENTER-TBI study",
journal="Journal of neurotrauma",
year="2020",
author="Zeiler, Frederick Adam and Mathieu, François and Monteiro, Miguel Aires Barros and Glocker, Ben and Ercole, Ari and Cabeleira, Manuel and Stocchetti, Nino and Smieleweski, Peter and Czosnyka, Marek and Newcombe, Virginia and Menon, David",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="The role of extra-cranial injury burden on cerebrovascular response in traumatic brain injury (TBI) is poorly documented. This study preliminarily assesses the association between admission features of extra-cranial injury burden on cerebrovascular reactivity. Using the CENTER-TBI HR ICU sub-study cohort, we evaluated those patients with both archived high-frequency digital intra-parenchymal ICP monitoring data of a minimum of 6 hours in duration, and the presence of a digital copy of their admission CT scan. Digital physiologic signals were processed for pressure reactivity index (PRx) and both the % time above defined PRx thresholds and mean hourly dose above threshold. This was conducted for both the first 72 hours and entire duration of recording. Admission extra-cranial injury characteristics and CT injury scores were obtained from the database, with quantitative contusion, edema, intraventricular hemorrhage (IVH) and extra-axial lesion volumes were obtained via semi-automated segmentation. Comparison between admission extra-cranial markers of injury and PRx metrics was conducted using Mann-U testing, and logistic regression techniques, adjusting for known CT injury metrics associated with impaired PRx. A total of 165 patients were included. Evaluating the entire ICU recording period, there was limited association between metrics of extra-cranial injury burden and impaired cerebrovascular reactivity. Using the first 72 hours of recording, admission temperature (p=0.042) and white blood cell % (WBC %) (p=0.013) were statistically associated with impaired cerebrovascular reactivity on Mann-U and univariate logistic regression. After adjusting for admission age, pupillary status, GCS motor score, pre-hospital hypoxia/hypotension and intra-cranial CT characteristics associated with impaired reactivity, temperature (p=0.021) and WBC % (p=0.013) remained significantly associated with mean PRx values above +0.25 and +0.35, respectively. Markers of extra-cranial injury burden do not appear to be strongly associated with impaired cerebrovascular reactivity in TBI, during both the initial and entire ICU stay. <br><br>KEYWORDS: autoregulation, cerebrovascular reactivity, extra-cranial injury, injury burden, TBI.<p /> <p>Language: en</p>",
language="en",
issn="0897-7151",
doi="10.1089/neu.2020.7304",
url="http://dx.doi.org/10.1089/neu.2020.7304"
}