Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside.
Brain Spine
; 4: 102760, 2024.
Article
in En
| MEDLINE
| ID: mdl-38510604
ABSTRACT
Introduction:
Continuous monitoring of the pressure reactivity index (PRx) provides an estimation of dynamic cerebral autoregulation (CA) at the bedside in traumatic brain injury (TBI) patients. Visualising the time-trend of PRx with a risk bar chart in ICM + software at the bedside allows for better real-time interpretability of the autoregulation status. When PRx>0.3 is sustained for long periods, typically of at least half an hour, the bar shows a pattern called "red solid line" (RSL). RSL was previously described to precede refractory intracranial hypertension and brain death. Research question We aimed to describe pathophysiological changes in measured signals/parameters during RSL. Material andmethods:
Observation of time-trends of PRx, intracranial pressure, cerebral perfusion pressure, brain oxygenation and compensatory reserve of TBI patients with RSL.Results:
Three pathophysiological patterns were identified RSL precedes intracranial hypertension, RSL is preceded by intracranial hypertension, or RSL is preceded by brain hypoperfusion. In all cases, RSL was followed by death and the RSL onset was between 1 h and 1 day before the terminal event. Discussion andconclusion:
RSL precedes death in intensive care and could represent a marker for terminal clinical deterioration in TBI patients. These findings warrant further investigations in larger cohorts to characterise pathophysiological mechanisms underlying the RSL pattern and whether RSL has a significant relationship with outcome after TBI.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
Brain Spine
Year:
2024
Document type:
Article
Affiliation country:
United kingdom
Country of publication:
Netherlands