Impaired Cerebral Autoregulation during Head Up Tilt in Patients with Severe Brain Injury

Christian Gunge Riberholt, Niels Damkjær Olesen, Mira Thing, Carsten Bogh Juhl, Jesper Mehlsen, Tue Hvass Petersen

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Resumé

Early mobilization is of importance for improving long-term outcome for patients after severe acquired brain injury. A limiting factor for early mobilization by head-up tilt is orthostatic intolerance. The purpose of the present study was to examine cerebral autoregulation in patients with severe acquired brain injury and a low level of consciousness. Fourteen patients with severe acquired brain injury and orthostatic intolerance and fifteen healthy volunteers were enrolled. Blood pressure was evaluated by pulse contour analysis, heart rate and RR-intervals were determined by electrocardiography, middle cerebral artery velocity was evaluated by transcranial Doppler, and near-infrared spectroscopy determined frontal lobe oxygenation in the supine position and during head-up tilt. Cerebral autoregulation was evaluated as the mean flow index calculated as the ratio between middle cerebral artery mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P < 0.001). Spectral analysis of heart rate variability in the frequency domain revealed lower magnitudes of ~0.1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury.

OriginalsprogEngelsk
Artikelnummere0154831
TidsskriftP L o S One
Vol/bind11
Udgave nummer5
Antal sider13
ISSN1932-6203
DOI
StatusUdgivet - 2016

Fingeraftryk

autoregulation
Brain
Homeostasis
brain
Early Ambulation
Middle Cerebral Artery
arteries
heart rate
Near infrared spectroscopy
Oxygenation
Near-Infrared Spectroscopy
Baroreflex
Supine Position
electrocardiography
consciousness
Blood pressure
near-infrared spectroscopy
Consciousness
Electrocardiography
Spectrum analysis

Citer dette

Riberholt, C. G., Olesen, N. D., Thing, M., Juhl, C. B., Mehlsen, J., & Petersen, T. H. (2016). Impaired Cerebral Autoregulation during Head Up Tilt in Patients with Severe Brain Injury. P L o S One, 11(5), [e0154831]. https://doi.org/10.1371/journal.pone.0154831
Riberholt, Christian Gunge ; Olesen, Niels Damkjær ; Thing, Mira ; Juhl, Carsten Bogh ; Mehlsen, Jesper ; Petersen, Tue Hvass. / Impaired Cerebral Autoregulation during Head Up Tilt in Patients with Severe Brain Injury. I: P L o S One. 2016 ; Bind 11, Nr. 5.
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Impaired Cerebral Autoregulation during Head Up Tilt in Patients with Severe Brain Injury. / Riberholt, Christian Gunge; Olesen, Niels Damkjær; Thing, Mira; Juhl, Carsten Bogh; Mehlsen, Jesper; Petersen, Tue Hvass.

I: P L o S One, Bind 11, Nr. 5, e0154831, 2016.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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AU - Mehlsen, Jesper

AU - Petersen, Tue Hvass

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N2 - Early mobilization is of importance for improving long-term outcome for patients after severe acquired brain injury. A limiting factor for early mobilization by head-up tilt is orthostatic intolerance. The purpose of the present study was to examine cerebral autoregulation in patients with severe acquired brain injury and a low level of consciousness. Fourteen patients with severe acquired brain injury and orthostatic intolerance and fifteen healthy volunteers were enrolled. Blood pressure was evaluated by pulse contour analysis, heart rate and RR-intervals were determined by electrocardiography, middle cerebral artery velocity was evaluated by transcranial Doppler, and near-infrared spectroscopy determined frontal lobe oxygenation in the supine position and during head-up tilt. Cerebral autoregulation was evaluated as the mean flow index calculated as the ratio between middle cerebral artery mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P < 0.001). Spectral analysis of heart rate variability in the frequency domain revealed lower magnitudes of ~0.1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury.

AB - Early mobilization is of importance for improving long-term outcome for patients after severe acquired brain injury. A limiting factor for early mobilization by head-up tilt is orthostatic intolerance. The purpose of the present study was to examine cerebral autoregulation in patients with severe acquired brain injury and a low level of consciousness. Fourteen patients with severe acquired brain injury and orthostatic intolerance and fifteen healthy volunteers were enrolled. Blood pressure was evaluated by pulse contour analysis, heart rate and RR-intervals were determined by electrocardiography, middle cerebral artery velocity was evaluated by transcranial Doppler, and near-infrared spectroscopy determined frontal lobe oxygenation in the supine position and during head-up tilt. Cerebral autoregulation was evaluated as the mean flow index calculated as the ratio between middle cerebral artery mean velocity and estimated cerebral perfusion pressure. Patients with acquired brain injury presented an increase in mean flow index during head-up tilt indicating impaired autoregulation (P < 0.001). Spectral analysis of heart rate variability in the frequency domain revealed lower magnitudes of ~0.1 Hz spectral power in patients compared to healthy controls suggesting baroreflex dysfunction. In conclusion, patients with severe acquired brain injury and orthostatic intolerance during head-up tilt have impaired cerebral autoregulation more than one month after brain injury.

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