gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Frequency of impaired cerebral autoregulation and intracranial compliance reduction is diagnosis specific

Die Frequenz von Autoregulationsstörung und reduzierter intrakranielle Compliance ist Diagnose-spezifisch

Meeting Abstract

  • presenting/speaker Martin Proescholdt - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Sylvia Bele - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Alexander Brawanski - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Nils Ole Schmidt - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Rupert Faltermeier - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP080

doi: 10.3205/21dgnc368, urn:nbn:de:0183-21dgnc3680

Veröffentlicht: 4. Juni 2021

© 2021 Proescholdt et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: In neurocritical care, impairment of cerebral autoregulation and reduced intracranial compliance due to brain swelling are frequent events. Recently, we have developed a biophysical approach to reliably detect these pathological conditions. Our method consists of a mathematical tool set, which detects slow homoeostatic correlation patterns between intracranial pressure (ICP) and arterial blood pressure (ABP). A negative correlation (scn) indicates reduced compliance and functioning autoregulation and a positive correlation (scp) implies additional disturbance of the cerebral autoregulation. In this study, we assessed, whether the frequency of the two conditions is different in patients with subarachnoid hemorrhage (SAH) compared or traumatic brain injury (TBI).

Methods: We have included 27 patients, with a median age of 44 years, treated for SAH (n = 18) or TBI (9) on our neurosurgical ICU. The median initial GCS was 7, the median GOS at last follow up was 3. Decompressive craniectomy was performed in 8 patients (29.6%). The baseline characteristics were balanced between the diagnosis groups, except for a male predominance and a higher frequency of craniectomy in the TBI group. To identify positive or negative correlations between isochronic segments of ABP and ICP, we utilized power spectra calculations. From this spectral information an index called selected correlation (sc) is deduced, which reflects the strength correlation. The mean Hilbert phase difference (mhpd) of the segments is calculated to reflect the phasing. If mhpd of ≥ 110 degree a correlation is defined as negative (scn). Conversely if mhpd ≤ 70 degree, the correlation is defined as positive (scp).

Results: We found a significantly higher proportion of scn in TBI patients compared to the SAH group (p = 0.035). In contrast, SAH patients showed a significantly higher fraction of scp indicating a higher frequency of impaired cerebral autoregulation. Neither scp, nor scp was different in patients with or without decompressive craniectomy (p = 0.104 and 0.827, respectively). Clinical outcome was not different between the diagnosis groups (p = 0.168). However, we found a significant correlation between scp and outcome (p = 0.002), which was not the case for scn (p = 0.276).

Conclusion: Our data demonstrate that the distribution of compliance reduction and autoregulation disturbance is different between TBI and SAH, highlighting the specific pathophysiology of the diseases.