Observation of Autoregulation Indices During Ventricular CSF Drainage After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

Marcel J. H. Aries*, Sytse F. de Jong, J. Marc C. van Dijk, Joost Regtien, Bart Depreitere, Marek Czosnyka, Peter Smielewski, Jan Willem J. Elting

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Scopus)

Abstract

Cerebral autoregulation is increasingly recognized as a factor that requires evaluation when managing poor grade aneurysmal subarachno <dal hemorrhage (aSAH) patients. In this single center pilot study, we investigated whether intraventricular intracranial pressure (ICP) derived when extraventricular drain (EVD) is open can be used to calculate dynamic autoregulation estimates in ICU aSAH patients.

Ten patients with the diagnosis of aSAH as confirmed by computed tomography (CT) and CT-angiography were enrolled. ICP was monitored via a transducer connected to the most proximal side exit of the EVD catheter. From at least 30 min periods of brain monitoring before, during, and after temporarily EVD closure, commonly used indexes of dynamic cerebral autoregulation were calculated.

Preserved pulsatile ICP signals were seen with open EVD. There were no significant changes in parameters describing cerebral autoregulation between EVD open and closed conditions. Power spectra of ABP and ICP showed no significant changes for the selected frequency ranges. There was a small significant increase in absolute ICP [2.4 (3.8) mmHg, p <0.001] upon short-term EVD closure. Cerebral spinal reserve capacity (RAP index) worsened significantly by short-term EVD closure.

Due to preserved slow fluctuations in the ICP signal, an open EVD system can be used to calculate dynamic autoregulation indices in aSAH patients requiring intensive care monitoring with the pressure measurement from the most proximal part of drain. If these results are confirmed in larger study, this technique can open the way for investigating the role of autoregulation disturbance in aSAH patients.

Original languageEnglish
Pages (from-to)347-354
Number of pages8
JournalNeurocritical care
Volume23
Issue number3
DOIs
Publication statusPublished - Dec-2015

Keywords

  • Aneurysmal subarachnoidal hemorrhage
  • Cerebrovascular pressure reactivity
  • Autoregulation
  • Cerebrospinal fluid drainage
  • INTRACRANIAL-PRESSURE
  • CEREBROVASCULAR AUTOREGULATION
  • CEREBRAL AUTOREGULATION
  • HEAD-INJURY
  • WAVE-FORM
  • REACTIVITY
  • VASOSPASM

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