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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Abstract

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.

Original languageEnglish
Article numbere0154831
JournalP L o S One
Volume11
Issue number5
Number of pages13
ISSN1932-6203
DOIs
Publication statusPublished - 2016

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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

Keywords

  • Journal Article

Cite this

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. In: P L o S One. 2016 ; Vol. 11, No. 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.

In: P L o S One, Vol. 11, No. 5, e0154831, 2016.

Research output: Contribution to journalJournal articleResearchpeer-review

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AU - Riberholt, Christian Gunge

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AU - Mehlsen, Jesper

AU - Petersen, Tue Hvass

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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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