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Intracranial Hypertension and Cerebral Autoregulation: A Systematic Review and Meta-Analysis

Marcelo de-Lima-Oliveira1, Angela S M Salinet1, Ricardo C Nogueira1

  • 1Division of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.

World Neurosurgery
|February 9, 2018
PubMed

Insights

This systematic review found that impaired cerebral autoregulation (CA) is common in patients with intracranial hypertension (high intracranial pressure). The findings highlight a significant association between elevated intracranial pressure and compromised brain blood flow regulation.

Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Neurology

Background:

  • Cerebral autoregulation (CA) is crucial for maintaining stable cerebral blood flow despite fluctuations in blood pressure.
  • Intracranial hypertension (ICH) is a common and serious complication in various neurological conditions, potentially leading to secondary brain injury.
  • Understanding the relationship between CA and ICH is vital for optimizing patient management and improving outcomes.

Purpose of the Study:

  • To systematically review and meta-analyze existing literature to establish the relationship between cerebral autoregulation (CA) and intracranial hypertension (ICH).
  • To quantify the degree of CA impairment in patients with elevated intracranial pressure (ICP).

Main Methods:

  • A comprehensive electronic search was conducted using terms related to cerebral autoregulation and intracranial hypertension.
  • Studies analyzing cerebral blood flow autoregulation in patients with intracranial pressure (ICP) monitoring were identified.
  • Data from eligible studies were synthesized using meta-analysis and sensitivity analyses.

Main Results:

  • Dynamic CA techniques were more frequently used (65.8%) than static techniques (26.3%).
  • Impaired CA was significantly associated with ICP levels ≥20 mmHg across various methodologies, including cerebral blood flow (SMD 5.44%, P=0.04) and moving correlation studies (SMD 0.06, P<0.00001).
  • A correlation was found between higher ICP and impaired CA (SMD 5.47, P=0.01), with patients having ICP ≥20 mmHg showing an elevated risk of impaired CA (OR 2.27, P=0.01).

Conclusions:

  • A consistent tendency towards impaired cerebral autoregulation was observed in patients experiencing increased intracranial pressure.
  • These findings underscore the clinical relevance of assessing CA in patients with ICH to guide therapeutic interventions.
Abstract

Keywords:
Acute liver failureCerebral autoregulationIntracranial hypertensionSubarachnoid hemorrhageTraumatic brain injury

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