Intracranial Pressure Monitoring, Heart Rate Variability, Baroreflex Sensitivity, and Signal Complexity During...

Area of Science:

• Neurology
• Critical Care Medicine
• Cardiovascular Physiology

Background:

• Malignant middle cerebral artery infarction (MMI) is a severe stroke subtype.
• Decompressive craniectomy (DC) followed by neurointensive care (NIC) is the standard treatment.
• Prognostic value of autonomic and complexity indices in MMI patients is not well understood.

Purpose of the Study:

• To investigate the prognostic significance of heart rate variability (HRV), baroreflex sensitivity (BRS), and signal complexity (SC) in MMI patients post-DC.
• To explore the relationship between these indices and demographics, stroke severity, NIC variables, and patient outcomes.

Main Methods:

• Retrospective analysis of 70 MMI patients undergoing ICP monitoring post-DC.
• Analysis of HRV, BRS, and SC (multiscale entropy) of heart rate, MAP, ICP, and ICP amplitude during the first seven NIC days.
• Correlation and multivariable logistic regression analyses to assess associations with demographics, NIC variables, and 6-month mRS.

Main Results:

• HRV and BRS were reduced post-DC but showed no significant associations with demographics, stroke severity, NIC variables, or mRS.
• Higher SC correlated with a lower burden of secondary insults.
• Higher SC of MAP, ICP, and ICP amplitude independently predicted lower 6-month mRS.

Conclusions:

• Lower systemic and cerebral SC are associated with a greater burden of secondary insults and worse long-term outcomes in MMI patients post-DC.
• Reduced SC may reflect overloaded compensatory mechanisms and decreased tolerance to secondary insults.
• SC holds potential for prognostication and optimizing NIC strategies to prevent autoregulatory insults.