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Published on: December 10, 2014
Hemispheric differences in cerebral autoregulation in children with moderate and severe traumatic brain injury
Monica S Vavilala1, Nuj Tontisirin, Yuthana Udomphorn
1Department of Anesthesiology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359724, Seattle, WA 98104, USA. vavilala@u.washington.edu
Insights
Hemispheric differences in cerebral autoregulation are common in children with traumatic brain injury (TBI). Intact autoregulation bilaterally may correlate with better outcomes.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Traumatic Brain Injury Research
Background:
- Traumatic brain injury (TBI) in children can affect cerebral autoregulation, the brain's ability to maintain blood flow.
- Understanding hemispheric differences in autoregulation is crucial for managing pediatric TBI.
- Cerebral autoregulation was assessed in pediatric TBI patients within 9 days of PICU admission.
Purpose of the Study:
- To investigate hemispheric variations in cerebral autoregulation among children with TBI.
- To determine the relationship between TBI type (focal vs. diffuse) and autoregulation patterns.
- To explore the association between cerebral autoregulation status and patient outcomes.
Main Methods:
- Static cerebral autoregulation testing was performed on pediatric TBI patients.
- The autoregulatory index (ARI) was used to quantify cerebral autoregulation.
- Patients were categorized based on TBI type (focal/diffuse) and CT findings.
Main Results:
- Cerebral autoregulation impairment was observed in at least one hemisphere in 54% of focal TBI and 28% of diffuse TBI cases.
- In isolated focal TBI, the affected hemisphere showed lower ARI (P=0.03), with autoregulation often impaired even on the non-TBI side.
- No hemispheric ARI difference was found in diffuse TBI (P=0.17). Patients with intact bilateral autoregulation trended towards better outcomes (GOS P=0.08).
Conclusions:
- Hemispheric differences in cerebral autoregulation are prevalent in pediatric focal TBI.
- Normal cerebral autoregulation on the contralateral side is not guaranteed, even with no visible TBI on CT.
- Intact bilateral cerebral autoregulation appears to be associated with improved outcomes in pediatric TBI patients.
Introduction:
To examine hemispheric differences in cerebral autoregulation in children with traumatic brain injury (TBI). After IRB approval and consent, subjects underwent static cerebral autoregulation testing during the first 9 days after PICU admission. Cerebral autoregulation was quantified using the autoregulatory index (ARI).
Results:
Forty-two (27 M:15 F) children (10 +/- 5 years) with TBI and admission Glasgow coma scale score (5 +/- 2) were enrolled. Seven (54%) of the 13 children with focal TBI and 8 (28%) of 29 children with diffuse TBI had impairment or absence of cerebral autoregulation of at least one hemisphere. In patients with isolated focal TBI, ARI was lower (0.40 +/- 0.40 vs. 0.67 +/- 0.40; P = 0.03) in the side of TBI than in the unaffected hemisphere, but cerebral autoregulation was often impaired on the side without TBI or shift (5/13) on head CT. There was no difference in ARI between hemispheres in children with diffuse TBI, with or without superimposed focal lesions (P = 0.17). Patients with bilateral intact cerebral autoregulation tended to have higher 6 month Glasgow Outcome Score (GOS) than patients with either unilateral or bilateral cerebral autoregulation impairment (GOS 4.0 +/- 0.60 vs. 3.6 +/- 0.80; P = 0.08).
Conclusions:
Hemispheric differences in cerebral autoregulation were common in children with isolated focal TBI. Absence of TBI on CT was not always associated with intact cerebral autoregulation. Patients with bilaterally intact cerebral autoregulation tended to have better outcomes.
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