AUTONOMIC NERVOUS SYSTEM ACTIVITY DURING REFRACTORY RISE IN INTRACRANIAL PRESSURE.

Fedriga, Marta; Czigler, Andras [Czigler, András (Általános orvos), szerző] Idegsebészeti Klinika (PTE / ÁOK); Szentágothai János Kutatóközpont (PTE); Transzlációs Medicina Intézet (PTE / ÁOK); Nasr, Nathalie; Zeiler, Frederick A; Park, Soojin; Donnelly, Joseph; Papaioannou, Vasilios; Frisvold, Shirin K; Wolf, Stefan; Rasulo, Francesco; Sykora, Marek; Smieleweski, Peter; Czosnyka, Marek

Angol nyelvű Tudományos Szakcikk (Folyóiratcikk)
  • SJR Scopus - Neurology (clinical): Q1
Azonosítók
Szakterületek:
    Refractory intracranial hypertension (RIH) is a dramatic increase in intracranial pressure (ICP) which cannot be controlled by treatment and can lead to death. Recent reports suggest that the autonomic nervous system (ANS) activity may be altered during changes in ICP. Our study aimed to assess ANS activity during RIH and the causal relationship between rising in ICP and autonomic activity. We retrospectively reviewed 24 multicentre (Cambridge, Tromso, Berlin) patients who developed RIH after acute brain injury (ABI). They were monitored with ICP, ABP, and ECG using ICM+software. Parameters reflecting autonomic activity were computed in time and frequency domain through the measurement of heart rate variability (HRV) and Baroreflex sensitivity (BRS). Our results demonstrated that a rise in ICP led to a significant rise in HRV and BRS with a higher significance level in the high-frequency HRV (p<0.001). This increase was followed by a significant decrease in HRV and BRS above the Upper-Breakpoint of ICP where ICP pulse-amplitude starts to decrease whereas the mean ICP continues to rise. Granger causality measures suggest a causal relationship from ICP to ANS. The above results suggest that a rise in ICP causes ANS activity mainly interacting with the parasympathetic-system. The ANS seems to react to the rise in ICP with a response possibly focused on maintaining the cerebrovascular homeostasis. This happens until the critical threshold of ICP is reached above which the ANS variables collapse, probably due to low perfusion of the brain and the central autonomic network.
    Hivatkozás stílusok: IEEEACMAPAChicagoHarvardCSLMásolásNyomtatás
    2021-05-13 08:50