Hypotension After Cardiac Operations Based on Autoregulation Monitoring Leads to Brain Cellular Injury

Daijiro Hori, Masahiro Ono, Thomas E. Rappold, John Conte, Ashish S. Shah, Duke E. Cameron, Hideo Adachi, Allen D. Everett, Charles W. Hogue

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background. Individualizing blood pressure targets could improve organ perfusion compared with current practices. In this study we assess whether hypotension defined by cerebral autoregulation monitoring vs standard definitions is associated with elevation in the brain-specific injury biomarker glial fibrillary acidic protein plasma levels (GFAP). Methods. Plasma GFAP levels were measured in 121 patients undergoing cardiac operations after anesthesia induction, at the conclusion of the operation, and on postoperative day 1. Cerebral autoregulation was monitored during the operation with the cerebral oximetry index, which correlates low-frequency changes in mean arterial pressure (MAP) and regional cerebral oxygen saturation. Blood pressure was recorded every 15 minutes in the intensive care unit. Hypotension was defined based on autoregulation data as an MAP below the optimal MAP (MAP at the lowest cerebral oximetry index) and based on standard definitions (systolic blood pressure decrement >20%, >30% from baseline, or <100 mm Hg, or both). Results. MAP (mean ± standard deviation) in the intensive care unit was 74 ± 7.3 mm Hg; optimal MAP was 78 ± 12.8 mm Hg (p = 0.008). The incidence of hypotension varied from 22% to 37% based on standard definitions but occurred in 54% of patients based on the cerebral oximetry index (p < 0.001). There was no relationship between standard definitions of hypotension and plasma GFAP levels, but MAP of less than optimal was positively related with postoperative day 1 GFAP levels (coefficient, 1.77; 95% confidence interval, 1.27 to 2.48; p = 0.001) after adjusting for GFAP levels at the conclusion of the operation and low cardiac output syndrome. Conclusions. Individualizing blood pressure management using cerebral autoregulation monitoring may better ensure brain perfusion than current practice.

Original languageEnglish (US)
Pages (from-to)487-493
Number of pages7
JournalAnnals of Thoracic Surgery
Volume100
Issue number2
DOIs
StatePublished - Aug 1 2015

Fingerprint

Hypotension
Brain Injuries
Arterial Pressure
Glial Fibrillary Acidic Protein
Homeostasis
Oximetry
Blood Pressure
Intensive Care Units
Blood Proteins
Perfusion
Low Cardiac Output
Anesthesia
Biomarkers
Confidence Intervals
Oxygen
Incidence
Brain

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hori, Daijiro ; Ono, Masahiro ; Rappold, Thomas E. ; Conte, John ; Shah, Ashish S. ; Cameron, Duke E. ; Adachi, Hideo ; Everett, Allen D. ; Hogue, Charles W. / Hypotension After Cardiac Operations Based on Autoregulation Monitoring Leads to Brain Cellular Injury. In: Annals of Thoracic Surgery. 2015 ; Vol. 100, No. 2. pp. 487-493.
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title = "Hypotension After Cardiac Operations Based on Autoregulation Monitoring Leads to Brain Cellular Injury",
abstract = "Background. Individualizing blood pressure targets could improve organ perfusion compared with current practices. In this study we assess whether hypotension defined by cerebral autoregulation monitoring vs standard definitions is associated with elevation in the brain-specific injury biomarker glial fibrillary acidic protein plasma levels (GFAP). Methods. Plasma GFAP levels were measured in 121 patients undergoing cardiac operations after anesthesia induction, at the conclusion of the operation, and on postoperative day 1. Cerebral autoregulation was monitored during the operation with the cerebral oximetry index, which correlates low-frequency changes in mean arterial pressure (MAP) and regional cerebral oxygen saturation. Blood pressure was recorded every 15 minutes in the intensive care unit. Hypotension was defined based on autoregulation data as an MAP below the optimal MAP (MAP at the lowest cerebral oximetry index) and based on standard definitions (systolic blood pressure decrement >20{\%}, >30{\%} from baseline, or <100 mm Hg, or both). Results. MAP (mean ± standard deviation) in the intensive care unit was 74 ± 7.3 mm Hg; optimal MAP was 78 ± 12.8 mm Hg (p = 0.008). The incidence of hypotension varied from 22{\%} to 37{\%} based on standard definitions but occurred in 54{\%} of patients based on the cerebral oximetry index (p < 0.001). There was no relationship between standard definitions of hypotension and plasma GFAP levels, but MAP of less than optimal was positively related with postoperative day 1 GFAP levels (coefficient, 1.77; 95{\%} confidence interval, 1.27 to 2.48; p = 0.001) after adjusting for GFAP levels at the conclusion of the operation and low cardiac output syndrome. Conclusions. Individualizing blood pressure management using cerebral autoregulation monitoring may better ensure brain perfusion than current practice.",
author = "Daijiro Hori and Masahiro Ono and Rappold, {Thomas E.} and John Conte and Shah, {Ashish S.} and Cameron, {Duke E.} and Hideo Adachi and Everett, {Allen D.} and Hogue, {Charles W.}",
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Hori, D, Ono, M, Rappold, TE, Conte, J, Shah, AS, Cameron, DE, Adachi, H, Everett, AD & Hogue, CW 2015, 'Hypotension After Cardiac Operations Based on Autoregulation Monitoring Leads to Brain Cellular Injury', Annals of Thoracic Surgery, vol. 100, no. 2, pp. 487-493. https://doi.org/10.1016/j.athoracsur.2015.03.036

Hypotension After Cardiac Operations Based on Autoregulation Monitoring Leads to Brain Cellular Injury. / Hori, Daijiro; Ono, Masahiro; Rappold, Thomas E.; Conte, John; Shah, Ashish S.; Cameron, Duke E.; Adachi, Hideo; Everett, Allen D.; Hogue, Charles W.

In: Annals of Thoracic Surgery, Vol. 100, No. 2, 01.08.2015, p. 487-493.

Research output: Contribution to journalArticle

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T1 - Hypotension After Cardiac Operations Based on Autoregulation Monitoring Leads to Brain Cellular Injury

AU - Hori, Daijiro

AU - Ono, Masahiro

AU - Rappold, Thomas E.

AU - Conte, John

AU - Shah, Ashish S.

AU - Cameron, Duke E.

AU - Adachi, Hideo

AU - Everett, Allen D.

AU - Hogue, Charles W.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background. Individualizing blood pressure targets could improve organ perfusion compared with current practices. In this study we assess whether hypotension defined by cerebral autoregulation monitoring vs standard definitions is associated with elevation in the brain-specific injury biomarker glial fibrillary acidic protein plasma levels (GFAP). Methods. Plasma GFAP levels were measured in 121 patients undergoing cardiac operations after anesthesia induction, at the conclusion of the operation, and on postoperative day 1. Cerebral autoregulation was monitored during the operation with the cerebral oximetry index, which correlates low-frequency changes in mean arterial pressure (MAP) and regional cerebral oxygen saturation. Blood pressure was recorded every 15 minutes in the intensive care unit. Hypotension was defined based on autoregulation data as an MAP below the optimal MAP (MAP at the lowest cerebral oximetry index) and based on standard definitions (systolic blood pressure decrement >20%, >30% from baseline, or <100 mm Hg, or both). Results. MAP (mean ± standard deviation) in the intensive care unit was 74 ± 7.3 mm Hg; optimal MAP was 78 ± 12.8 mm Hg (p = 0.008). The incidence of hypotension varied from 22% to 37% based on standard definitions but occurred in 54% of patients based on the cerebral oximetry index (p < 0.001). There was no relationship between standard definitions of hypotension and plasma GFAP levels, but MAP of less than optimal was positively related with postoperative day 1 GFAP levels (coefficient, 1.77; 95% confidence interval, 1.27 to 2.48; p = 0.001) after adjusting for GFAP levels at the conclusion of the operation and low cardiac output syndrome. Conclusions. Individualizing blood pressure management using cerebral autoregulation monitoring may better ensure brain perfusion than current practice.

AB - Background. Individualizing blood pressure targets could improve organ perfusion compared with current practices. In this study we assess whether hypotension defined by cerebral autoregulation monitoring vs standard definitions is associated with elevation in the brain-specific injury biomarker glial fibrillary acidic protein plasma levels (GFAP). Methods. Plasma GFAP levels were measured in 121 patients undergoing cardiac operations after anesthesia induction, at the conclusion of the operation, and on postoperative day 1. Cerebral autoregulation was monitored during the operation with the cerebral oximetry index, which correlates low-frequency changes in mean arterial pressure (MAP) and regional cerebral oxygen saturation. Blood pressure was recorded every 15 minutes in the intensive care unit. Hypotension was defined based on autoregulation data as an MAP below the optimal MAP (MAP at the lowest cerebral oximetry index) and based on standard definitions (systolic blood pressure decrement >20%, >30% from baseline, or <100 mm Hg, or both). Results. MAP (mean ± standard deviation) in the intensive care unit was 74 ± 7.3 mm Hg; optimal MAP was 78 ± 12.8 mm Hg (p = 0.008). The incidence of hypotension varied from 22% to 37% based on standard definitions but occurred in 54% of patients based on the cerebral oximetry index (p < 0.001). There was no relationship between standard definitions of hypotension and plasma GFAP levels, but MAP of less than optimal was positively related with postoperative day 1 GFAP levels (coefficient, 1.77; 95% confidence interval, 1.27 to 2.48; p = 0.001) after adjusting for GFAP levels at the conclusion of the operation and low cardiac output syndrome. Conclusions. Individualizing blood pressure management using cerebral autoregulation monitoring may better ensure brain perfusion than current practice.

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