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Secondary Cerebral Ischemia at Traumatic Brain Injury Is More Closely Related to Cerebrovascular Reactivity Impairment than to Intracranial Hypertension

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Intracranial Pressure and Neuromonitoring XVII

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 131))

Summary

The purpose of this study was to investigate the relationship between the development of secondary cerebral ischemia (SCI), intracranial pressure (ICP) and cerebrovascular reactivity (CVR) after traumatic brain injury (TBI). Methods: 89 patients with severe TBI with ICP monitoring were studied retrospectively. The mean age was 36.3 ± 4.8 years, 53 men, 36 women. The median Glasgow Coma Score (GCS) was 6.2 ± 0.7. The median Injury Severity Score was 38.2 ± 12.5. To specify the degree of impact of changes in ICP and CVR on the SCI progression in TBI patients, logistic regression was performed. Significant p-values were <0.05. Results: The deterioration of CVR in combination with the severity of ICP has a significant impact on the increase in the prevalence rate of SCI. A logistic regression analysis for a model of SCI dependence on intracranial hypertension and CVR was performed. The results of the analysis showed that CVR was the most significant factor affecting SCI development in TBI. Conclusions: The development of SCI in severe TBI depends largely on CVR impairment and to a lesser extent on ICP level. Treatment for severe TBI patients with SCI progression should not be aimed solely at intracranial hypertension correction but also at CVR recovery.

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Acknowledgments

DB was supported by NIH R01NS112808-01. AT was supported by a Grant-in-Aid for Exploratory Research from the Privolzhsky Research Medical University.

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Authors and Affiliations

  1. Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia

    Michael Dobrzeniecki, Alex Trofimov, Dmitry Martynov, Darya Agarkova & Ksenia Trofimova

  2. Department of Neurosurgery, Children’s Clinical and Research Institute of Emergency Surgery and Trauma, Moscow, Russia

    Zhanna B. Semenova

  3. Lovelace Biomedical Research Institute, Albuquerque, NM, USA

    Denis E. Bragin

  4. Department of Neurosurgery, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, NM, USA

    Denis E. Bragin

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  1. Michael Dobrzeniecki
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  2. Alex Trofimov
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  3. Dmitry Martynov
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  4. Darya Agarkova
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  5. Ksenia Trofimova
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  6. Zhanna B. Semenova
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  7. Denis E. Bragin
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Editors and Affiliations

  1. Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium

    Bart Depreitere

  2. Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium

    Geert Meyfroidt

  3. Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium

    Fabian Güiza

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Dobrzeniecki, M. et al. (2021). Secondary Cerebral Ischemia at Traumatic Brain Injury Is More Closely Related to Cerebrovascular Reactivity Impairment than to Intracranial Hypertension. In: Depreitere, B., Meyfroidt, G., Güiza, F. (eds) Intracranial Pressure and Neuromonitoring XVII. Acta Neurochirurgica Supplement, vol 131. Springer, Cham. https://doi.org/10.1007/978-3-030-59436-7_32

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  • DOI: https://doi.org/10.1007/978-3-030-59436-7_32

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-59435-0

  • Online ISBN: 978-3-030-59436-7

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