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  • Title: Cerebral venous volume changes and pressure autoregulation in critically ill infants.
    Author: Govindan V, Govindan R, Massaro AN, Al-Shargabi T, Andescavage NN, Vezina G, Murnick J, Wang Y, Metzler M, Cristante C, Swisher C, Reich D, Plessis AD.
    Journal: J Perinatol; 2020 May; 40(5):806-811. PubMed ID: 32157219.
    Abstract:
    OBJECTIVE: To determine whether ventilator-related fluctuations in cerebral blood volume (CBV) are associated with cerebral pressure passivity. STUDY DESIGN: In a prospective study of newborns undergoing positive-pressure ventilation, we calculated coherence between continuous mean arterial pressure (MAP) and cerebral near-infrared spectroscopy hemoglobin difference (HbD). Significant HbD-MAP coherence indicated cerebral pressure passivity. CBV changes were measured as the spectral power of total hemoglobin (SHbT) at the ventilator frequency. A regression model tested whether SHbT predicts cerebral pressure passivity and/or death/brain injury, controlling for birth gestational age and other factors. RESULTS: We studied 68 subjects with prematurity (n = 19), congenital heart disease (n = 11), and hypoxic-ischemic encephalopathy (n = 38). SHbT, sedative use, and pCO2 were positively associated, and circulating hemoglobin negatively associated, with cerebral pressure passivity (p < 0.001), which was positively associated with brain injury (p < 0.001). CONCLUSION: In sick newborns, ventilator-related CBV fluctuations may predispose to cerebral pressure passivity, which may predispose to an adverse neonatal outcome.
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