Failure of cerebral autoregulation in an experimental diffuse brain injury model

The normal cerebral circulation has the ability to maintain a stable cerebral blood flow over a wide range of cerebral perfusion pressures and this is known as cerebral autoregulation. Autoregulation may be impaired in the injured brain. Closed head injury was induced in 28 Sprague-Dawley rats weighing 400-450 g. Four groups were studied: control and groups, head injured by weight drop from one meter height using 350 g, 400 g and 450 g respectively. CBF was monitored using laser-Doppler flowmetry along with monitoring of ICP and arterial blood pressure. If the correlation coefficient between CBF and CPP was > 0.85 and CPP was within normal range, loss of autoregulation was hypothesized. Loss of autoregulation was seen in all groups of injured rats during first four hours. A statistically significant difference (p = 0.041) was seen in the trequency of loss of autoregulation between injured and control animals. No loss of autoregulation was observed in the control group. In conclusion CBF and CPP provide information about loss of autoregulation in diffuse brain injury. Decrease in CBF and increase of ICP is observed as a result of loss of cerebral autoregulation. Knowledge of loss of autoregulation could help in the management of head injured patients.