Document Detail


Age, intracranial pressure, autoregulation, and outcome after brain trauma.
MedLine Citation:
PMID:  15796378     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The object of this study was to investigate whether a failure of cerebrovascular autoregulation contributes to the relationship between age and outcome in patients following head injury. METHODS: Data obtained from continuous bedside monitoring of intracranial pressure (ICP), arterial blood pressure (ABP), and cerebral perfusion pressure (CPP = ABP - ICP) in 358 patients with head injuries and intermittent monitoring of transcranial Doppler blood flow velocity (FV) in the middle cerebral artery in 237 patients were analyzed retrospectively. Indices used to describe cerebral autoregulation and pressure reactivity were calculated as correlation coefficients between slow waves of systolic FV and CPP (autoregulation index [ARI]) and between ABP and ICP (pressure reactivity index [PRI]). Older patients had worse outcomes after brain trauma than younger patients (p = 0.00001), despite the fact that the older patients had higher initial Glasgow Coma Scale scores (p = 0.006). When age was considered as an independent variable, it appeared that ICP decreased with age (p = 0.005), resulting in an increasing mean CPP (p = 0.0005). Blood FV was not dependent on age (p = 0.58). Indices of autoregulation and pressure reactivity demonstrated a deterioration in cerebrovascular control with advancing age (PRI: p = 0.003; ARI: p = 0.007). CONCLUSIONS: An age-related decline in cerebrovascular autoregulation was associated with a relative deterioration in outcome in elderly patients following head trauma.
Authors:
Marek Czosnyka; Marcella Balestreri; Luzius Steiner; Piotr Smielewski; Peter J Hutchinson; Basil Matta; John D Pickard
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  102     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-30     Completed Date:  2005-04-15     Revised Date:  2007-04-03    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  450-4     Citation Subset:  AIM; IM    
Affiliation:
Academic Neurosurgical Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. mc141@medschl.cam.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Blood Flow Velocity
Brain Injuries / physiopathology*
Cerebrovascular Circulation / physiology*
Female
Homeostasis / physiology*
Humans
Intracranial Pressure / physiology*
Male
Middle Aged
Middle Cerebral Artery / physiopathology
Retrospective Studies
Comments/Corrections
Comment In:
J Neurosurg. 2007 Mar;106(3):516; author reply 516-7   [PMID:  17367084 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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