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Cerebral vasomotor reactivity testing in head injury: the link between pressure and flow
  1. E W Lang1,
  2. J Lagopoulos2,
  3. J Griffith1,
  4. K Yip1,
  5. A Yam1,
  6. Y Mudaliar3,
  7. H M Mehdorn4,
  8. N W C Dorsch1
  1. 1Department of Neurosurgery, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
  2. 2Department of Neurology, Westmead Hospital, University of Sydney
  3. 3Department of Intensive Care, Westmead Hospital, University of Sydney
  4. 4Department of Neurosurgery, Christian-Albrechts-Universität, Kiel, Germany
  1. Correspondence to:
 Dr Erhard W Lang, Department of Neurosurgery, Weimarer Strasse 8, D-24106 Kiel, Germany

Abstract

Background: It has been suggested that a moving correlation index between mean arterial blood pressure and intracranial pressure, called PRx, can be used to monitor and quantify cerebral vasomotor reactivity in patients with head injury.

Objectives: To validate this index and study its relation with cerebral blood flow velocity and cerebral autoregulation; and to identify variables associated with impairment or preservation of cerebral vasomotor reactivity.

Methods: The PRx was validated in a prospective study of 40 head injured patients. A PRx value of less than 0.3 indicates intact cerebral vasomotor reactivity, and a value of more than 0.3, impaired reactivity. Arterial blood pressure, intracranial pressure, mean cerebral perfusion pressure, and cerebral blood flow velocity, measured bilaterally with transcranial Doppler ultrasound, were recorded. Dynamic cerebrovascular autoregulation was measured using a moving correlation coefficient between arterial blood pressure and cerebral blood flow velocity, the Mx, for each cerebral hemisphere. All variables were compared in patients with intact and impaired cerebral vasomotor reactivity.

Results: No correlation between arterial blood pressure or cerebral perfusion pressure and cerebral blood flow velocity was seen in 19 patients with intact cerebral vasomotor reactivity. In contrast, the correlation between these variables was significant in 21 patients with impaired cerebral vasomotor reactivity, whose cerebral autoregulation was reduced. There was no correlation with intracranial pressure, arterial blood pressure, cerebral perfusion pressure, or interhemispheric cerebral autoregulation differences, but the values for these indices were largely within normal limits.

Conclusions: The PRx is valid for monitoring and quantifying cerebral vasomotor reactivity in patients with head injury. This intracranial pressure based index reflects changes in cerebral blood flow and cerebral autoregulatory capacity, suggesting a close link between blood flow and intracranial pressure in head injured patients. This explains why increases in arterial blood pressure and cerebral perfusion pressure may be useful for reducing intracranial pressure in selected head injured patients (those with intact cerebral vasomotor reactivity).

  • cerebrovascular reactivity
  • cerebral autoregulation
  • intracranial pressure
  • head injury

https://doi.org/10.1136/jnnp.74.8.1053

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    Footnotes

    • Competing interests: EW has received financial support for conference attendances from DWL, the manufacturer of the Doppler equipment, and B Braun, Australia, the distributor of the ICP device. EWL and JG run educational courses for Getz Bros, the distributor of the Doppler equipment in Australia, for which they charge a fee.