{ "labelLang" : "eng", "responseDate" : "2024-03-29 11:47", "content" : { "otype" : "JournalArticle", "mtid" : 31722247, "status" : "VALIDATED", "published" : true, "comment" : "Funding Agency and Grant Number: Manitoba Public Insurance (MPI) Neuroscience/TBI Research Endowment; Canada Foundation for Innovation (CFI) [38583]; Research Manitoba [3906]; University of Manitoba - Department of Surgery GFT Research Grant; University of Manitoba Office of Research Services (ORS) - University Research Grant Program (URGP); Health Sciences Centre Foundation Winnipeg; United States National Institutes of Health (NIH) through the National Institute of Neurological Disorders and Stroke (NINDS); Canadian Institutes of Health Research (CIHR); Canada Foundation for Innovation (CFI), Research Manitoba; University of Manitoba VPRI Research Investment Fund (RIF); University of Manitoba Centre on Aging; University of Manitoba Rudy Falk ClinicianScientist Professorship; University of Manitoba Department of Surgery GFT Research Grant; Centre on Aging Fellowship at the University of Manitoba; University of Manitoba Clinician Investigator Program\n Funding text: This work was supported directly through the Manitoba Public Insurance (MPI) Neuroscience/TBI Research Endowment providing infrastructures and disposable support; the Canada Foundation for Innovation (CFI) (Project #: 38583), Research Manitoba (Grant #: 3906), University of Manitoba - Department of Surgery GFT Research Grant providing graduate student salary support; and the University of Manitoba Office of Research Services (ORS) -University Research Grant Program (URGP) providing hardware support. The sponsor had no role in the design or conduct of this research. FAZ receives research support from the Manitoba Public Insurance (MPI) Neuroscience/TBI Research Endowment, the Health Sciences Centre Foundation Winnipeg, the United States National Institutes of Health (NIH) through the National Institute of Neurological Disorders and Stroke (NINDS), the Canadian Institutes of Health Research (CIHR), the Canada Foundation for Innovation (CFI), Research Manitoba, the University of Manitoba VPRI Research Investment Fund (RIF), the University of Manitoba Centre on Aging, and the University of Manitoba Rudy Falk ClinicianScientist Professorship. LF is supported by the University of Manitoba Department of Surgery GFT Research Grant and the University of Manitoba Office of Research Services (ORS) - University Research Grant Program (URGP). CB is supported by the Centre on Aging Fellowship at the University of Manitoba. 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"snippet" : true }, "volume" : "162", "issue" : "11", "firstPage" : "2683", "lastPage" : "2693", "firstPageOrInternalIdForSort" : "2683", "pageLength" : 11, "publishedYear" : 2020, "abstractText" : "Background Intravenous hypertonic saline is utilized commonly in critical care for treatment of acute or refractory elevations of intracranial pressure (ICP) in traumatic brain injury (TBI) patients. Though there is a clear understanding of the general physiological effects of a hypertonic saline solution over long periods of time, smaller epoch effects of hypertonic saline (HTS) have not been thoroughly analyzed. The aim of this study was to perform a direct evaluation of the high-frequency response of HTS on the cerebrovascular physiological responses in TBI. Methods We retrospectively reviewed our prospectively maintained adult TBI database for those with archived high-frequency cerebral physiology and available HTS treatment information. We evaluated different epochs of physiology around HTS bolus dosing, comparing pre- with post-HTS. We assessed for changes in slow fluctuations in ICP, pulse amplitude of ICP (AMP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), cerebrovascular reactivity (as measured through pressure reactivity index (PRx)), and cerebral compensatory reserve (correlation (R) between AMP (A) and ICP (P)). Comparisons of mean measures and percentage time above clinically relevant thresholds for the physiological parameters were compared pre- and post-HTS using descriptive statistics and Mann-WhitneyUtesting. We assessed for subgroups of physiological responses using latent profile analysis (LPA). Results Fifteen patients underwent 69 distinct bolus infusions of hypertonic saline. Apart from the well-documented decrease in ICP, there was also a reduction in AMP. The analysis of cerebrovascular reactivity response to HTS solution had two main effects. For patients with grossly impaired cerebrovascular reactivity pre-HTS (PRx > + 0.30), HTS bolus led to improved reactivity. However, for those with intact cerebrovascular reactivity pre-HTS (PRx < 0), HTS bolus demonstrated a trend towards more impaired reactivity. This indicates that HTS has different impacts, dependent on pre-bolus cerebrovascular status. There was no significant change in metrics of cerebral compensatory reserve. LPA failed to demonstrate any subgroups of physiological responses to HTS administration. Conclusions The direct decrease in ICP and AMP confirms that a bolus dose of a HTS solution is an effective therapeutic agent for intracranial hypertension. However, in patients with intact autoregulation, hypertonic saline may impair cerebral hemodynamics. These findings regarding cerebrovascular reactivity remain preliminary and require further investigation.", "subjects" : [ { "otype" : "Classification", "mtid" : 12215, "link" : "/api/classification/12215", "label" : "Clinical medicine", "published" : true, "snippet" : true } ], "keywords" : [ { "otype" : "Keyword", "mtid" : 9928, "link" : "/api/keyword/9928", "label" : "Cerebrovascular Circulation", "published" : true, "oldId" : 9928, "snippet" : true }, { "otype" : "Keyword", "mtid" : 1011913, "link" : "/api/keyword/1011913", "label" : "sodium chloride", "published" : true, "oldId" : 1011913, "snippet" : true }, { "otype" : "Keyword", "mtid" : 1030654, "link" : "/api/keyword/1030654", "label" : "Intracranial Pressure", "published" : true, "oldId" : 1030654, "snippet" : true }, { "otype" : "Keyword", "mtid" : 1103203, "link" : "/api/keyword/1103203", "label" : "HYPERTONIC SALINE", "published" : true, "oldId" : 1103203, "snippet" : true }, { "otype" : "Keyword", "mtid" : 1756855, "link" : "/api/keyword/1756855", "label" : "cerebrovascular response", "published" : true, "snippet" : true }, { "otype" : "Keyword", "mtid" : 1866382, "link" : "/api/keyword/1866382", "label" : "Pressure reactivity index", "published" : true, "snippet" : true } ], "digital" : null, "printed" : null, "sourceYear" : 2020, "foreignEdition" : true, "foreignLanguage" : true, "fullPublication" : true, "conferencePublication" : false, "nationalOrigin" : null, "missingAuthor" : false, "oaType" : "NONE", "oaCheckDate" : "2024-03-01", "oaFree" : false, "citationCount" : 0, "citationCountUnpublished" : 0, "citationCountWoOther" : 0, "independentCitCountWoOther" : 0, "doiCitationCount" : 0, "wosCitationCount" : 0, "scopusCitationCount" : 0, "independentCitationCount" : 0, "unhandledCitationCount" : 0, "citingPubCount" : 0, "independentCitingPubCount" : 0, "unhandledCitingPubCount" : 0, "citedPubCount" : 4, "citedCount" : 4, "ratings" : [ { "otype" : "SjrRating", "mtid" : 10861867, "link" : "/api/sjrrating/10861867", "label" : "sjr:Q2 (2020) Scopus - Neurology (clinical) ACTA NEUROCHIRURGICA 0001-6268 0942-0940", "listPos" : 176, "rankValue" : 0.49, "type" : "journal", "ratingType" : { "otype" : "RatingType", "mtid" : 10002, "link" : "/api/ratingtype/10002", "label" : "sjr", "code" : "sjr", "published" : true, "snippet" : true }, "subject" : { "otype" : "ClassificationExternal", "mtid" : 2728, "link" : "/api/classificationexternal/2728", "label" : "Scopus - Neurology (clinical)", "published" : true, "oldId" : 2728, "snippet" : true }, "ranking" : "Q2", "calculation" : "DIRECT", "published" : true, "snippet" : true } ], "ratingsForSort" : "Q2", "hasCitationDuplums" : false, "directInstitutesForSort" : "", "ownerAuthorCount" : 4, "ownerInstituteCount" : 32, "directInstituteCount" : 0, "authorCount" : 6, "contributorCount" : 0, "hasQualityFactor" : true, "link" : "/api/publication/31722247", "label" : "Froese Logan et al. 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