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Boots R, Xue G, Tromp D, Rawashdeh O, Bellapart J, Townsend S, Rudd M, Winter C, Mitchell G, Garner N, Clement P, Karamujic N, Zappala C. Circadian Rhythmicity of Vital Signs at Intensive Care Unit Discharge and Outcome of Traumatic Brain Injury. Am J Crit Care 2022; 31:472-482. [PMID: 36316179 DOI: 10.4037/ajcc2022821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Physiological functions with circadian rhythmicity are often disrupted during illness. OBJECTIVE To assess the utility of circadian rhythmicity of vital signs in predicting outcome of traumatic brain injury (TBI). METHODS A retrospective single-center cohort study of adult intensive care unit (ICU) patients with largely isolated TBI to explore the relationship between the circadian rhythmicity of vital signs during the last 24 hours before ICU discharge and clinical markers of TBI severity and score on the Glasgow Outcome Scale 6 months after injury (GOS-6). RESULTS The 130 study participants had a median age of 39.0 years (IQR, 23.0-59.0 years), a median Glasgow Coma Scale score at the scene of 8.0 (IQR, 3.0-13.0), and a median Rotterdam score on computed tomography of the head of 3 (IQR, 3-3), with 105 patients (80.8%) surviving to hospital discharge. Rhythmicity was present for heart rate (30.8% of patients), systolic blood pressure (26.2%), diastolic blood pressure (20.0%), and body temperature (26.9%). Independent predictors of a dichotomized GOS-6 ≥4 were the Rotterdam score (odds ratio [OR], 0.38 [95% CI, 0.18-0.81]; P = .01), Glasgow Coma Scale score at the scene (OR, 1.22 [95% CI, 1.05-1.41]; P = .008), age (OR, 0.95 [95% CI, 0.92-0.98]; P = .003), oxygen saturation <90% in the first 24 hours (OR, 0.19 [95% CI, 0.05-0.73]; P = .02), serum sodium level <130 mmol/L (OR, 0.20 [95% CI, 0.05-0.70]; P = .01), and active intracranial pressure management (OR, 0.16 [95% CI, 0.04-0.62]; P = .008), but not rhythmicity of any vital sign. CONCLUSION Circadian rhythmicity of vital signs at ICU discharge is not predictive of GOS-6 in patients with TBI.
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Affiliation(s)
- Rob Boots
- Rob Boots is an associate professor, Thoracic Medicine, Royal Brisbane and Women's Hospital, a senior specialist, Intensive Care, Bundaberg Hospital, Faculty of Medicine, The University of Queensland, Herston, and a professsor, Faculty of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - George Xue
- George Xue is the medical registrar, Royal Brisbane and Women's Hospital
| | - Dirk Tromp
- Dirk Tromp is the senior radiology registrar, Royal Brisbane and Women's Hospital
| | - Oliver Rawashdeh
- Oliver Rawashdeh is director, Chronobiology and Sleep Research, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Judith Bellapart
- Judith Bellapart is a senior specialist, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, and Burns, Trauma, and Critical Care, The University of Queensland
| | - Shane Townsend
- Shane Townsend is director, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Michael Rudd
- Michael Rudd is acting director, Trauma, Royal Brisbane and Women's Hospital
| | - Craig Winter
- Craig Winter is a staff specialist neurosurgeon, Royal Brisbane and Women's Hospital
| | - Gary Mitchell
- Gary Mitchell is a staff specialist, Emergency Medicine, Royal Brisbane and Women's Hospital
| | - Nicholas Garner
- Nicholas Garner is a PhD student, Chronobiology and Sleep Research Lab, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Pierre Clement
- Pierre Clement is a clinical information systems manager, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Nermin Karamujic
- Nermin Karamujic is a data manager and clinical information systems manager, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Christopher Zappala
- Christopher Zappala is a senior staff specialist, Thoracic Medicine, Royal Brisbane and Women's Hospital
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Herbowski L. Circadian Biorhythmicity in Normal Pressure Hydrocephalus - A Case Series Report. J Korean Neurosurg Soc 2021; 65:151-160. [PMID: 34929078 PMCID: PMC8752883 DOI: 10.3340/jkns.2021.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
Continuous monitoring of intracranial pressure is a well established medical procedure. Still, little is known about long-term behavior of intracranial pressure in normal pressure hydrocephalus. The present study is designed to evaluate periodicity of intracranial pressure over long-time scales using intraventricular pressure monitoring in patients with normal pressure hydrocephalus. In addition, the circadian and diurnal patterns of blood pressure and body temperature in those patients are studied. Four patients, selected with “probable” normal pressure hydrocephalus, were monitored for several dozen hours. Intracranial pressure, blood pressure, and body temperature were recorded hourly. Autocorrelation functions were calculated and cross-correlation analysis were carried out to study all the time-series data. Autocorrelation results show that intracranial pressure, blood pressure, and body temperature values follow bimodal (positive and negative) curves over a day. The cross-correlation functions demonstrate causal relationships between intracranial pressure, blood pressure, and body temperature. The results show that long-term fluctuations in intracranial pressure exhibit cyclical patterns with periods of about 24 hours. Continuous intracranial pressure recording in “probable” normal pressure hydrocephalus patients reveals circadian fluctuations not related to the day and night cycle. These fluctuations are causally related to changes in blood pressure and body temperature. The present study reveals the complete loss of the diurnal blood pressure and body temperature rhythmicities in patients with “probable” normal pressure hydrocephalus.
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Affiliation(s)
- Leszek Herbowski
- Department of Neurosurgery and Neurotraumatology, Independent Public Regional Hospital, Szczecin, Poland
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Nogueira AB, Annen E, Boss O, Farokhzad F, Sikorski C, Keller E. Temperature variability in the day-night cycle is associated with further intracranial pressure during therapeutic hypothermia. J Transl Med 2017; 15:170. [PMID: 28774294 PMCID: PMC5543542 DOI: 10.1186/s12967-017-1272-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background To assess whether circadian patterns of temperature correlate with further values of intracranial pressure (ICP) in severe brain injury treated with hypothermia. Methods We retrospectively analyzed temperature values in subarachnoid hemorrhage patients treated with hypothermia by endovascular cooling. The circadian patterns of temperature were correlated with the mean ICP across the following day (ICP24). Results We analyzed data from 17 days of monitoring of three subarachnoid hemorrhage patients that underwent aneurysm coiling, sedation and hypothermia due to refractory intracranial hypertension and/or cerebral vasospasm. ICP24 ranged from 11.5 ± 3.1 to 24.2 ± 6.2 mmHg. The ratio between the coefficient of variation of temperature during the nocturnal period (18:00–6:00) and the preceding diurnal period (6:00–18:00) [temperature variability (TV)] ranged from 0.274 to 1.97. Regression analysis showed that TV correlated with ICP24 (Pearson correlation = −0.861, adjusted R square = 0.725, p < 0.001), and that ICP24 = 6 (4–TV) mmHg or, for 80% prediction interval, \documentclass[12pt]{minimal}
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\begin{document}$${\text{ICP}}_{24} = 23.9 - 6.22\,\times\,{\text{TV }} \pm 1.73\,\times\sqrt {1.06 + (({\text{TV}} - 1.1)^{2} /4.49)}$$\end{document}ICP24=23.9-6.22×TV±1.73×1.06+((TV-1.1)2/4.49) mmHg. The results indicate that the occurrence of ICP24 higher than 20 mmHg is unlikely after a day with TV ≥1.0. Conclusions TV correlates with further ICP during hypothermia regardless the strict range that temperature is maintained. Further studies with larger series could clarify whether intracranial hypertension in severe brain injury can be predicted by analysis of oscillation patterns of autonomic parameters across a period of 24 h or its harmonics. Electronic supplementary material The online version of this article (doi:10.1186/s12967-017-1272-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adriano Barreto Nogueira
- Division of Neurosurgery Clinic, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, 255 Dr. Eneas de Carvalho Aguiar Ave, Sao Paulo, 05403-900, Brazil. .,Neurocritical Care Unit, Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Eva Annen
- Neurocritical Care Unit, Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Oliver Boss
- Neurocritical Care Unit, Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Faraneh Farokhzad
- Neurocritical Care Unit, Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Christopher Sikorski
- Neurocritical Care Unit, Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Emanuela Keller
- Neurocritical Care Unit, Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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