Cerebral Hemodynamics

Continuous Optical Monitoring of Cerebral Hemodynamics During Head-of-Bed Manipulation in Brain-Injured Adults

Authors: Kim MN, Edlow BL, Durduran T, Frangos S, Mesquita RC, Levine JM, Greenberg JH, Yodh AG, Detre JA.

INTRODUCTION: Head-of-bed manipulation is commonly performed in the neurocritical care unit to optimize cerebral blood flow (CBF), but its effects on CBF are rarely measured. This pilot study employs a novel, non-invasive instrument combining two techniques, diffuse correlation spectroscopy (DCS) for measurement of CBF and near-infrared spectroscopy (NIRS) for measurement of cerebral oxy- and deoxy-hemoglobin concentrations, to monitor patients during head-of-bed lowering.

Effects of Indomethacin Test on Intracranial Pressure and Cerebral Hemodynamics in Patients with Refractory Intracranial Hypertension: A Feasibility Study

Authors: Godoy DA, Rabinstein AA, Biestro A, Ainslie PN, Napoli MD.

BACKGROUND: Intracranial hypertension is the final pathway of many neurocritical entities, such as spontaneous intracerebral hemorrhage (sICH) and severe traumatic brain injury (sTBI).
OBJECTIVE: To determine: (1) alterations in intracranial pressure (ICP) and cerebral hemodynamics following an Indomethacin (INDO) infusion test and the related association with survival in patients with refractory intracranial hypertension (RICH) secondary to sICH or sTBI; and (2) to assess the safety profile following INDO.
METHODS: INDO was administered in a loading dose (.8 mg/kg/15 minutes), followed by a 2-hour continuous infusion (.5 mg/kg/h) in RICH patients with ICP>20 mmHg who did not respond to first line therapies. Changes in ICP, cerebral perfusion pressure (CPP) and cerebrovascular variables (assessed by transcranial Doppler and jugular bulb saturation) were observed. Clinical outcome was assessed at 1 and 6 months according to Glasgow Outcome Scale and correlated to INDO infusion test response. Analysis of INDO safety profile was conducted.
RESULTS: Thirteen sICH and 10 sTBI patients were studied. Median GCS score at admission was 6. Within 30 minutes of INDO infusion, ICP decreased (42.0±13.5 vs. 27.70±12.7 mmHg; D%:-48.4%; P<.001), and both CPP (57.7±4.8 vs. 71.9±7.0 mmHg; D%:+26.0%; P<.001) and middle cerebral artery velocity (35.2±5.6 vs. 42.0±5.1 cm•sec; D%:+26.1%; P<.001) increased. The CPP response to 2-hour INDO infusion test was correlated (R: .72; P<.001) to survival. No adverse events were observed following INDO.
CONCLUSION: Our findings support the effectivness and feasibility of an INDO test in reducing ICP and improving cerebral hemodynamics in surviving RICH patients. Future studies to evaluate different doses, lengths of infusion and longer-term effects are needed.

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