2.50
Hdl Handle:
http://hdl.handle.net/10755/211695
Type:
Research Study
Title:
BARORECEPTOR SENSITIVITY IDENTIFIES NORMAL BRAIN BLOOD CONTROL in BRAIN INJURY
Abstract:
Background/Aims: Cerebral autoregulation (CA) is abnormal in patients with traumatic brain injury (TBI) and leads to secondary brain injury. Such secondary injury can be induced by common nursing procedures, such as sitting and ambulation. Standard measures of CA are not amenable to routine clinical use. Baroreceptor sensitivity (BRS) is a non-invasive measure of autonomic tone and shares some of the same neurological pathways as CA.  Thus, BRS may be a useful clinical marker for CA in patients with TBI. The relationship of CA and BRS in patients with TBI is unclear. The specific aim of this research was to evaluate BRS and CA in a group of patients with moderate to severe TBI. Methods: CA (cerebral artery blood flow velocity measured in the left middle cerebral artery using transcranial Doppler) and BRS were examined in 26 TBI subjects (age 37.04+14.51 years; 18 males) 30 seconds prior to (baseline) and 30 seconds after a postural challenge. CA and BRS were classified as normal or abnormal per published norms. Statistical analyses consisted of t-tests, Pearson’s correlations and chi-square with significance set at p < 0.05. Sensitivity and specificity of BRS to detect abnormal CA were also evaluated. Results: There were significant differences between CA at baseline and post position (baseline: 53.53 ± 10.13; post: 50.40 ± 10.87, p = 0.005) However,  there was no significant difference in BRS between these time points (baseline: 13.62 ± 3.57; post: 13.73 ± 2.92, p = 0.86). CA was abnormal in 6 subjects and BRS was abnormal in 6 subjects, but both CA and BRS were abnormal in only one subject. Ability of BRS to identify abnormal CA (sensitivity) was low (true abnormal CA = 1; 5%) but its ability to classify normal CA (specificity) was high (true normal BRS and CA = 19; 76%). Implications: BRS can identify normal CA and may be a useful clinical method to evaluate nursing procedure readiness, such as position changes, ambulation, or Trendelenberg position. Thus BRS may have clinical utility to assess the presence of normal CA and decrease the risk of secondary brain injury in TBI patients.  
Keywords:
Cerebral autoregulation; Traumatic brain injury; Nursing procedures
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
4908
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleBARORECEPTOR SENSITIVITY IDENTIFIES NORMAL BRAIN BLOOD CONTROL in BRAIN INJURYen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211695-
dc.description.abstractBackground/Aims: Cerebral autoregulation (CA) is abnormal in patients with traumatic brain injury (TBI) and leads to secondary brain injury. Such secondary injury can be induced by common nursing procedures, such as sitting and ambulation. Standard measures of CA are not amenable to routine clinical use. Baroreceptor sensitivity (BRS) is a non-invasive measure of autonomic tone and shares some of the same neurological pathways as CA.  Thus, BRS may be a useful clinical marker for CA in patients with TBI. The relationship of CA and BRS in patients with TBI is unclear. The specific aim of this research was to evaluate BRS and CA in a group of patients with moderate to severe TBI. Methods: CA (cerebral artery blood flow velocity measured in the left middle cerebral artery using transcranial Doppler) and BRS were examined in 26 TBI subjects (age 37.04+14.51 years; 18 males) 30 seconds prior to (baseline) and 30 seconds after a postural challenge. CA and BRS were classified as normal or abnormal per published norms. Statistical analyses consisted of t-tests, Pearson’s correlations and chi-square with significance set at p < 0.05. Sensitivity and specificity of BRS to detect abnormal CA were also evaluated. Results: There were significant differences between CA at baseline and post position (baseline: 53.53 ± 10.13; post: 50.40 ± 10.87, p = 0.005) However,  there was no significant difference in BRS between these time points (baseline: 13.62 ± 3.57; post: 13.73 ± 2.92, p = 0.86). CA was abnormal in 6 subjects and BRS was abnormal in 6 subjects, but both CA and BRS were abnormal in only one subject. Ability of BRS to identify abnormal CA (sensitivity) was low (true abnormal CA = 1; 5%) but its ability to classify normal CA (specificity) was high (true normal BRS and CA = 19; 76%). Implications: BRS can identify normal CA and may be a useful clinical method to evaluate nursing procedure readiness, such as position changes, ambulation, or Trendelenberg position. Thus BRS may have clinical utility to assess the presence of normal CA and decrease the risk of secondary brain injury in TBI patients.  en_GB
dc.subjectCerebral autoregulationen_GB
dc.subjectTraumatic brain injuryen_GB
dc.subjectNursing proceduresen_GB
dc.date.available2012-02-20T12:08:57Z-
dc.date.issued2012-02-20T12:08:57Z-
dc.date.accessioned2012-02-20T12:08:57Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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