Temporal relationship between vasopressor and sedative administration and cerebrovascular response in traumatic brain injury: a time-series analysis

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Date
2023-05-29
Authors
Froese, Logan
Gomez, Alwyn
Sainbhi, Amanjyot S.
Vakitbilir, Nuray
Marquez, Izabella
Amenta, Fiorella
Stein, Kevin Y.
Zeiler, Frederick A.
Journal Title
Journal ISSN
Volume Title
Publisher
SpringerOpen
Abstract
Abstract Background Although vasopressor and sedative agents are commonly used within the intensive care unit to mediate systemic and cerebral physiology, the full impact such agents have on cerebrovascular reactivity remains unclear. Using a prospectively maintained database of high-resolution critical care and physiology, the time-series relationship between vasopressor/sedative administration, and cerebrovascular reactivity was interrogated. Cerebrovascular reactivity was assessed through intracranial pressure and near infrared spectroscopy measures. Using these derived measures, the relationship between hourly dose of medication and hourly index values could be evaluated. The individual medication dose change and their corresponding physiological response was compared. Given the high number of doses of propofol and norepinephrine, a latent profile analysis was used to identify any underlying demographic or variable relationships. Finally, using time-series methodologies of Granger causality and vector impulse response functions, the relationships between the cerebrovascular reactivity derived variables were compared. Results From this retrospective observational study of 103 TBI patients, the evaluation between the changes in vasopressor or sedative agent dosing and the previously described cerebral physiologies was completed. The assessment of the physiology pre/post infusion agent change resulted in similar overall values (Wilcoxon signed-ranked p value > 0.05). Time series methodologies demonstrated that the basic physiological relationships were identical before and after an infusion agent was changed (Granger causality demonstrated the same directional impact in over 95% of the moments, with response function being graphically identical). Conclusions This study suggests that overall, there was a limited association between the changes in vasopressor or sedative agent dosing and the previously described cerebral physiologies including that of cerebrovascular reactivity. Thus, current regimens of administered sedative and vasopressor agents appear to have little to no impact on cerebrovascular reactivity in TBI.
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Keywords
autoregulation, cerebrovascular reactivity, sedative drugs, vasopressors
Citation
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
Intensive Care Medicine Experimental. 2023 May 29;11(1):30
URI
http://hdl.handle.net/1993/37362
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University of Manitoba Scholarship