Publication: Early cardiovascular function and associated hemodynamics in adults with isolated moderate-severe traumatic brain injury: A pilot study
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Issued Date
2019-11-01
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ISSN
15322653
09675868
09675868
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2-s2.0-85071489559
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Clinical Neuroscience. Vol.69, (2019), 97-103
Suggested Citation
Nophanan Chaikittisilpa, Monica S. Vavilala, Abhijit V. Lele, Anne E. Moore, Justin Bethel, Vijay Krishnamoorthy Early cardiovascular function and associated hemodynamics in adults with isolated moderate-severe traumatic brain injury: A pilot study. Journal of Clinical Neuroscience. Vol.69, (2019), 97-103. doi:10.1016/j.jocn.2019.08.024 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/51341
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Title
Early cardiovascular function and associated hemodynamics in adults with isolated moderate-severe traumatic brain injury: A pilot study
Abstract
© 2019 Background: While cardiac dysfunction has been described following traumatic brain injury (TBI), its association with systemic and cerebral hemodynamics is not known. We examined the contemporaneous relationship between early cardiac function with systemic and cerebral hemodynamic parameters after moderate-severe TBI. Methods: Bedside transthoracic echocardiography (TTE) and transcranial Doppler (TCD) ultrasonography were performed within 24 h in patients > 18 years with isolated moderate-severe TBI. Systemic hemodynamic parameters were quantified using routine monitoring [heart rate and mean arterial pressures (MAP)] and calculation from echocardiographic data [stroke volume index (SVI), cardiac index (CI), and systemic vascular resistance index (SVRI)]. Systolic dysfunction was defined using TTE as global longitudinal strain (GLS) > -16%. Mean middle cerebral artery velocity (FVm) was the measure of cerebral hemodynamics and quantified using TCD. Results: Among 15 patients [mean age 43 ± 13 years, GCS 5 ± 3, 73% male], 15 TTE and 15 TCD exams were performed simultaneously. Five (33%) patients had systolic dysfunction, with significantly worse GLS (median [IQR] −12.1% [−14.1, −12] vs. −19.1% [−19.9, −17.7], p = 0.004). Median (IQR) MAP was 97 (89, 107) mmHg, SVI (29.0 [20.5, 31.0] mL m−2), and CI (2.83 [2.05, 3.10] L/min m−2) were low to normal, while SVRI (2704 dyne sec/cm5 m−2 [2210, 4084]) was normal to high. None of the patients had abnormal TCDs. Higher GLS (reduced systolic function) was associated with lower SVI (r2 = 0.274, p = 0.03) but not other parameters. Conclusion: Systemic hemodynamic parameters were consistent with an early catecholamine-excess state. While reduced systolic function was associated with lower SVI, there was no relationship with reduced cerebral perfusion, possibly due to normal MAP.