Back to Search Start Over

Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study

Authors :
Bruno Martins Tomazini
Sâmia Yasin Wayhs
Edson Bor-Seng-Shu
Ricardo de Carvalho Nogueira
Luiz Marcelo Sá Malbouisson
Sérgio T. Fonseca
Sérgio Brasil
Wellingson Silva Paiva
Bruno Lucena
Estevão Bassi
Filippo Annoni
Alexis F. Turgeon
Manoel Jacobsen Teixeira
Marcelo de-Lima-Oliveira
Fabio Silvio Taccone
Source :
Brain Sciences, Vol 11, Iss 874, p 874 (2021), Brain sciences, 11 (7, Brain Sciences, Volume 11, Issue 7
Publication Year :
2021
Publisher :
MDPI AG, 2021.

Abstract

Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission<br />CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00–1.28] vs. 1.00 [0.88–1.16]<br />p = 0.03) and eICP (14 [11–25] vs. 11 [7–15] mmHg<br />p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8–12] vs. 6 [5–7]<br />p &lt<br />0.001) than those with a favorable outcome<br />the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75–0.97)<br />a score &gt<br />8.5 had 63 (46–77)% sensitivity and 87 (62–97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5–31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome.

Details

ISSN :
20763425
Volume :
11
Database :
OpenAIRE
Journal :
Brain Sciences
Accession number :
edsair.doi.dedup.....9bd98161f1511a7e3d6e8085d7ec594f
Full Text :
https://doi.org/10.3390/brainsci11070874