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Cerebral blood flow velocity and autoregulation in paediatric patients following a global hypoxic-ischaemic insult

  • Author Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.
    Marlina E. Lovett
    Correspondence
    Corresponding author at: Division of Critical Care Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, United States.
    Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.
    Affiliations
    Division of Critical Care Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
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  • Author Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.
    Tensing Maa
    Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.
    Affiliations
    Division of Critical Care Medicine, Nationwide Children’s Hospital, Columbus, OH, United States

    Department of Paediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
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  • Author Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.
    Melissa G. Chung
    Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.
    Affiliations
    Division of Critical Care Medicine, Nationwide Children’s Hospital, Columbus, OH, United States

    Department of Paediatrics, The Ohio State University College of Medicine, Columbus, OH, United States

    Division of Neurology, Nationwide Children’s Hospital, Columbus, OH, United States
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  • Author Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.
    Nicole F. O’Brien
    Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.
    Affiliations
    Division of Critical Care Medicine, Nationwide Children’s Hospital, Columbus, OH, United States

    Department of Paediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
    Search for articles by this author
  • Author Footnotes
    1 Location of Research: Nationwide Children’s Hospital, Columbus, OH.

      Abstract

      Aim

      To describe the cerebral blood flow velocity pattern and investigate cerebral autoregulation using transcranial Doppler ultrasonography (TCD) following a global hypoxic-ischaemic (HI) event in children.

      Methods

      This was a prospective, observational study in a quaternary-level paediatric intensive care unit. Intubated children, newborn to 17 years admitted to the PICU following HI injury (asphyxia, drowning, cardiac arrest) were eligible for inclusion. TCD was performed daily until post-injury day 8, discharge, or death, whichever occurred earliest.

      Results

      Twenty-six patients were enrolled. Median age was 3 years (0.33, 11.75), initial pH 6.95, and initial lactate 5.4. Median post-resuscitation Glasgow Coma Score was 3T. Across the entire cohort, cerebral blood flow velocity (CBFV) was near normal on day 1. Flow velocity increased to a maximum median value of 1.4 standard deviations above normal on day 3 and slowly downtrended back to baseline by the end of the study period. Median Paediatric Extended Version of the Glasgow Outcome Score was 4 at three months. No patient in the favourable outcome group had extreme CBFV on day one, and only one patient in the favourable group had extreme CBFV on PID 2. In contrast, 38% of patients in the unfavourable group had extreme CBFV on PID 1 (p=.039 compared to frequency in favourable group), and 55% had extreme CBFV on PID 2 (p = .023 compared to frequency in favourable group). No patient had consistently intact cerebral autoregulation throughout the study period.

      Conclusions

      Following a HI event, patients with favourable neurologic outcomes had flow velocity near normal whereas unfavourable outcomes had more extreme flow velocity. Intermittently intact cerebral autoregulation was more frequently seen in those with favourable neurologic outcomes though return to the autoregulatory baseline appears delayed.

      Keywords

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