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Lee JK, Brady KM, Chung SE, Jennings JM, Whitaker EE, Aganga D, Easley RB, Heitmiller K, Jamrogowicz JL, Larson AC, Lee JH, Jordan LC, Hogue CW, Lehmann CU, Bembea MM, Hunt EA, Koehler RC, Shaffner DH. A pilot study of cerebrovascular reactivity autoregulation after pediatric cardiac arrest. Resuscitation 2014; 85:1387-93. [PMID: 25046743 DOI: 10.1016/j.resuscitation.2014.07.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 06/26/2014] [Accepted: 07/07/2014] [Indexed: 11/17/2022]
Abstract
AIM Improved survival after cardiac arrest has placed greater emphasis on neurologic resuscitation. The purpose of this pilot study was to evaluate the relationship between cerebrovascular autoregulation and neurologic outcomes after pediatric cardiac arrest. METHODS Children resuscitated from cardiac arrest had autoregulation monitoring during the first 72h after return of circulation with an index derived from near-infrared spectroscopy in a pilot study. The range of mean arterial blood pressure (MAP) with optimal vasoreactivity (MAPOPT) was identified. The area under the curve (AUC) of the time spent with MAP below MAPOPT and MAP deviation below MAPOPT was calculated. Neurologic outcome measures included placement of a new tracheostomy or gastrostomy, death from a primary neurologic etiology (brain death or withdrawal of support for neurologic futility), and change in the Pediatric Cerebral Performance Category score (ΔPCPC). RESULTS Thirty-six children were monitored. Among children who did not require extracorporeal membrane oxygenation (ECMO), children who received a tracheostomy/gastrostomy had greater AUC during the second 24h after resuscitation than those who did not (P=0.04; n=19). Children without ECMO who died from a neurologic etiology had greater AUC during the first 48h than did those who lived or died from cardiovascular failure (P=0.04; n=19). AUC below MAPOPT was not associated with ΔPCPC when children with or without ECMO were analyzed separately. CONCLUSIONS Deviation from the blood pressure with optimal autoregulatory vasoreactivity may predict poor neurologic outcomes after pediatric cardiac arrest. This experimental autoregulation monitoring technique may help individualize blood pressure management goals after resuscitation.
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Affiliation(s)
- Jennifer K Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA.
| | - Ken M Brady
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA
| | - Shang-En Chung
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, JHU, USA; Center for Child and Community Health Research, JHU, USA
| | - Jacky M Jennings
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, JHU, USA; Center for Child and Community Health Research, JHU, USA
| | - Emmett E Whitaker
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Devon Aganga
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Ronald B Easley
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA
| | - Kerry Heitmiller
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Jessica L Jamrogowicz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Abby C Larson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Jeong-Hoo Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Lori C Jordan
- Department of Neurology, Vanderbilt University (VU), Nashville, TN, USA
| | - Charles W Hogue
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Christoph U Lehmann
- Department of Pediatrics, VU, USA; Department of Biomedical Informatics, VU, USA
| | - Mela M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Elizabeth A Hunt
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Raymond C Koehler
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
| | - Donald H Shaffner
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University (JHU), Baltimore, MD, USA
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Szabo K, Rosengarten B, Juhasz T, Lako E, Csiba L, Olah L. Effect of non-steroid anti-inflammatory drugs on neurovascular coupling in humans. J Neurol Sci 2013; 336:227-31. [PMID: 24262992 DOI: 10.1016/j.jns.2013.10.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Neuronal activation induced cerebral blood flow increase was shown in animal experiments to require the presence of functioning cyclooxygenase. Our aim was to study whether widely used, non-steroid anti-inflammatory drugs (NSAIDs), given orally in usual therapeutic doses, inhibit neurovascular coupling in humans. METHODS By using a visual cortex stimulation paradigm, the flow velocity response was measured by transcranial Doppler sonography in both posterior cerebral arteries of fifteen young healthy adults. The investigation was repeated in the same subjects after 2-day administration of 3×25 mg indomethacin (indomethacin phase) and 2×550 mg naproxen (naproxen phase). Visual-evoked-potentials were also recorded during the control phase and after administration of NSAIDs. RESULTS Basal flow velocity significantly decreased while the pulsatility index increased after administration of either indomethacin or naproxen (p<0.01). Despite unchanged visual-evoked-potentials, the visually evoked flow velocity increase (26±7% in the control phase) significantly declined after administration of indomethacin (19±5%; p<0.01) or naproxen (20±5%; p<0.02). CONCLUSION Oral administration of indomethacin or naproxen in their usual therapeutic doses significantly impaired the resting and the visually evoked blood flow regulations in healthy human subjects. Together with stable evoked potentials, our findings indicate disturbance of neurovascular coupling.
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Affiliation(s)
- Katalin Szabo
- Department of Neurology, Medical and Health Science Center, University of Debrecen, H-4032 Debrecen, Moricz Zs. str. 22, Hungary
| | - Bernhard Rosengarten
- Department of Neurology, Medical and Health Science Center, University of Debrecen, H-4032 Debrecen, Moricz Zs. str. 22, Hungary
| | - Tunde Juhasz
- Department of Neurology, Medical and Health Science Center, University of Debrecen, H-4032 Debrecen, Moricz Zs. str. 22, Hungary
| | - Eva Lako
- Department of Neurology, Medical and Health Science Center, University of Debrecen, H-4032 Debrecen, Moricz Zs. str. 22, Hungary
| | - Laszlo Csiba
- Department of Neurology, Medical and Health Science Center, University of Debrecen, H-4032 Debrecen, Moricz Zs. str. 22, Hungary
| | - Laszlo Olah
- Department of Neurology, Medical and Health Science Center, University of Debrecen, H-4032 Debrecen, Moricz Zs. str. 22, Hungary.
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Howlett JA, Northington FJ, Gilmore MM, Tekes A, Huisman TA, Parkinson C, Chung SE, Jennings JM, Jamrogowicz JJ, Larson AC, Lehmann CU, Jackson E, Brady KM, Koehler RC, Lee JK. Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy. Pediatr Res 2013; 74:525-35. [PMID: 23942555 PMCID: PMC3954983 DOI: 10.1038/pr.2013.132] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/31/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neonates with hypoxic-ischemic encephalopathy (HIE) are at risk of cerebral blood flow dysregulation. Our objective was to describe the relationship between autoregulation and neurologic injury in HIE. METHODS Neonates with HIE had autoregulation monitoring with the hemoglobin volume index (HVx) during therapeutic hypothermia, rewarming, and the first 6 h of normothermia. The 5-mm Hg range of mean arterial blood pressure (MAP) with best vasoreactivity (MAPOPT) was identified. The percentage of time spent with MAP below MAPOPT and deviation in MAP from MAPOPT were measured. Neonates received brain magnetic resonance imaging (MRI) 3-7 d after treatment. MRIs were coded as no, mild, or moderate/severe injury in five regions. RESULTS HVx identified MAPOPT in 79% (19/24), 77% (17/22), and 86% (18/21) of the neonates during hypothermia, rewarming, and normothermia, respectively. Neonates with moderate/severe injury in paracentral gyri, white matter, basal ganglia, and thalamus spent a greater proportion of time with MAP below MAPOPT during rewarming than neonates with no or mild injury. Neonates with moderate/severe injury in paracentral gyri, basal ganglia, and thalamus had greater MAP deviation below MAPOPT during rewarming than neonates without injury. CONCLUSION Maintaining MAP within or above MAPOPT may reduce the risk of neurologic injuries in neonatal HIE.
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Affiliation(s)
- Jessica A. Howlett
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine (JHU), Baltimore, MD,Neurosciences Intensive Care Nursery Program, JHU
| | - Frances J. Northington
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine (JHU), Baltimore, MD,Neurosciences Intensive Care Nursery Program, JHU
| | - Maureen M. Gilmore
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine (JHU), Baltimore, MD,Neurosciences Intensive Care Nursery Program, JHU
| | - Aylin Tekes
- Neurosciences Intensive Care Nursery Program, JHU,Department of Radiology, Division of Pediatric Radiology, JHU
| | - Thierry A.G.M. Huisman
- Neurosciences Intensive Care Nursery Program, JHU,Department of Radiology, Division of Pediatric Radiology, JHU
| | - Charlamaine Parkinson
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine (JHU), Baltimore, MD,Neurosciences Intensive Care Nursery Program, JHU
| | - Shang-En Chung
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, JHU,Center for Child and Community Health Research (CCHR), JHU
| | - Jacky M. Jennings
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, JHU,Center for Child and Community Health Research (CCHR), JHU
| | | | - Abby C. Larson
- Department of Anesthesiology and Critical Care Medicine, JHU
| | - Christoph U. Lehmann
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine (JHU), Baltimore, MD
| | - Eric Jackson
- Department of Anesthesiology and Critical Care Medicine, JHU
| | - Ken M. Brady
- Department of Anesthesiology, Texas Children’s Hospital, Houston, TX
| | | | - Jennifer K. Lee
- Neurosciences Intensive Care Nursery Program, JHU,Department of Anesthesiology and Critical Care Medicine, JHU
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Vuletic V, Drenjancevic I, Rahelic D, Demarin V. Effect of indomethacin on cerebrovascular reactivity in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2013; 101:81-7. [PMID: 23684449 DOI: 10.1016/j.diabres.2013.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/21/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
AIM Impaired cerebral vasoreactivity to endothelium-dependent stimuli were described in type 2 diabetes mellitus (T2DM), but the mechanisms underlying that impairment are still unclear. The aim of this study was to investigate the role of cyclooxygenases' metabolites in response to acute hypercapnic stimulus in cerebral vessels, in patients with T2DM. METHODS Vascular responses in the breath-holding test (BHT) were assessed in the absence/presence of a non-selective, reversible-inhibitor of cyclooxygenases, indomethacin (INDO), by functional transcranial Doppler sonography of the middle cerebral artery (N of patients=50; 33 men and 17 women). The functional hemodynamic parameter mean flow velocity (MFV) was assessed at rest, before and 90min after 100mg of INDO, and during the BHT. Breath holding index (BHI) [(MFV at the end of BHT minus MFV at rest)/MFV at rest)×100/s of breath-holding] was calculated after BHT performed before and 90min after INDO. RESULTS MFV at rest significantly decreased after INDO administration compared with a control condition before INDO (at rest before INDO from 49.36±15.09 to 36.72±8.45 after INDO, p<0.001) However, overall cerebral vessel vasoreactivity to hypercapnia, evaluated with BHI, was significantly improved after INDO administration compared with the BHI before INDO administration (from 0.68±0.4 to 1.27±0.42, p<0.001). CONCLUSIONS The improvement in cerebral vasoreactivity in response to BHT after INDO administration suggests that the production of a vasoconstrictor metabolite of cyclooxygenase in diabetic patients was reduced by indomethacin consumption.
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Affiliation(s)
- Vladimira Vuletic
- Department of Neurology, Dubrava University Hospital, Zagreb, Croatia.
| | - Ines Drenjancevic
- Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip, Juraj Strossmayer, Osijek, Croatia
| | - Dario Rahelic
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dubrava University Hospital, Zagreb, Croatia
| | - Vida Demarin
- Medical Director, Medical Centre "Aviva", Zagreb, Croatia
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Hoffmeyer HW, Enager P, Thomsen KJ, Lauritzen MJ. Nonlinear neurovascular coupling in rat sensory cortex by activation of transcallosal fibers. J Cereb Blood Flow Metab 2007; 27:575-87. [PMID: 16896350 DOI: 10.1038/sj.jcbfm.9600372] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Functional neuroimaging and normal brain function rely on the robust coupling between neural activity and cerebral blood flow (CBF), that is neurovascular coupling. We examined neurovascular coupling in rat sensory cortex in response to direct stimulation of transcallosal pathways, which allows examination of brain regions inaccessible to peripheral stimulation techniques. Using laser-Doppler flowmetry to record CBF and electrophysiologic recordings of local field potentials (LFPs), we show an exponential relation between CBF responses and summed LFP amplitudes. Hemodynamic responses were dependent on glutamate receptor activation. CNQX, an AMPA receptor blocker, strongly attenuated evoked CBF responses and LFP amplitudes at all stimulation frequencies. In comparison, N-methyl D-aspartate (NMDA) receptor blockade by MK801 attenuated CBF responses at high (>7 Hz) but not low (<7 Hz) stimulation frequencies, without affecting evoked LFP amplitudes. This shows the limitation of using LFP amplitudes as indicators of synaptic activity. 7-Nitroindazole, a neuronal nitric oxide synthase inhibitor, and indomethacin, a nonspecific cyclooxygenase inhibitor, attenuated the hemodynamic responses by 50%+/-1% and 48%+/-1%, respectively, without affecting LFP amplitudes. The data suggest that preserved activity of both AMPA and NMDA receptors is necessary for the full CBF response evoked by stimulation of rodent interhemispheric connections. AMPA receptor activation gives rise to a measurable LFP, but NMDA receptor activation does not. The lack of a measurable LFP from neural processes that contribute importantly to CBF may explain some of the difficulties in transforming extracellular current or voltage measurements to a hemodynamic response.
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Affiliation(s)
- Henrik W Hoffmeyer
- Department of Medical Physiology, The Panum Institute, University of Copenhagen, Copenhagen N, Denmark
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Takano T, Tian GF, Peng W, Lou N, Libionka W, Han X, Nedergaard M. Astrocyte-mediated control of cerebral blood flow. Nat Neurosci 2005; 9:260-7. [PMID: 16388306 DOI: 10.1038/nn1623] [Citation(s) in RCA: 813] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 12/02/2005] [Indexed: 12/12/2022]
Abstract
Local increase in blood flow during neural activity forms the basis for functional brain imaging, but its mechanism remains poorly defined. Here we show that cortical astrocytes in vivo possess a powerful mechanism for rapid vasodilation. We imaged the activity of astrocytes labeled with the calcium (Ca(2+))-sensitive indicator rhod-2 in somatosensory cortex of adult mice. Photolysis of caged Ca(2+) in astrocytic endfeet ensheathing the vessel wall was associated with an 18% increase in arterial cross-section area that corresponded to a 37% increase in blood flow. Vasodilation occurred with a latency of only 1-2 s, and both indomethacin and the cyclooxygenase-1 inhibitor SC-560 blocked the photolysis-induced hyperemia. These observations implicate astrocytes in the control of local microcirculation and suggest that one of their physiological roles is to mediate vasodilation in response to increased neural activity.
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Affiliation(s)
- Takahiro Takano
- Center for Aging and Developmental Biology, Department of Neurosurgery, University of Rochester Medical School, 601 Elmwood Avenue, Rochester, New York 14642, USA.
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Abstract
Indomethacin has been suggested as a therapeutic tool to manage elevated intracranial pressure in patients with severe head injury and patients undergoing craniotomy for brain tumors. Indomethacin is a non-selective cyclooxygenase inhibitor. Compared to other cyclooxygenase inhibitors indomethacin has unique effects on cerebral blood flow. Administration of indomethacin causes cerebral vasoconstriction and decreases cerebral blood flow, which elicits a decrease in intracranial pressure. The mechanism of indomethacin-induced cerebral vasoconstriction is not completely understood and controversies exist whether indomethacin causes cerebral ischemia. The primary aims of this article were to review the existing knowledge of indomethacin's influence upon cerebral hemodynamics and elevated ICP in patients with brain pathology. Furthermore, indomethacin's mechanism of action and whether it causes cerebral ischemia are discussed.
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Affiliation(s)
- M Rasmussen
- Department of Neuroanesthesia, Arhus University Hospital, 8000 Arhus C, Denmark.
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