Changes in autonomic nervous system during cerebral desaturation episodes in aneurysmal subarachnoid hemorrhage

Agnieszka Uryga; Nathalie Nasr; Magdalena Kasprowicz; Jowita Woźniak; Waldemar Goździk; Małgorzata Burzyńska

doi:10.1016/j.autneu.2022.102968

Changes in autonomic nervous system during cerebral desaturation episodes in aneurysmal subarachnoid hemorrhage

Auton Neurosci. 2022 May:239:102968. doi: 10.1016/j.autneu.2022.102968. Epub 2022 Feb 24.

Authors

Agnieszka Uryga¹, Nathalie Nasr², Magdalena Kasprowicz³, Jowita Woźniak⁴, Waldemar Goździk⁵, Małgorzata Burzyńska⁵

Affiliations

¹ Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wroclaw, Poland. Electronic address: agnieszka.uryga@pwr.edu.pl.
² INSERM UMR 1297, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France; Department of Neurology, Toulouse University Hospital, Toulouse, France.
³ Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wroclaw, Poland.
⁴ Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland.
⁵ Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland.

PMID: 35276619
DOI: 10.1016/j.autneu.2022.102968

Abstract

Introduction: Little evidence is available on the effect of regional cerebral desaturation (rCD) episodes that occur in the first days after aneurysm subarachnoid haemorrhage (aSAH) on the autonomic nervous system activity and on cardiovascular hemodynamics. In this study, we aimed to determine the impact of rCD episodes, developed within 5 days of aSAH, on the autonomic nervous system based on the assessment of baroreflex sensitivity (BRS) and on cardiac output (CO) and cardiac index (CI), and on cerebral autoregulation (CA).

Materials and methods: Of 96 patients with aSAH, 36 patients (aged 57 (48-69)) met the inclusion criteria and were included in the study. Regional cerebral oxygen saturation and rCD episodes were evaluated using near-infrared spectroscopy. CA was quantified by the correlation coefficient (TOxa). Cardiac output (CO) and cardiac index (CI) were monitored using the FloTrack®/EV1000. Baroreflex sensitivity (BRS) was assessed using the cross-correlation method. Scores of 1 to 3 in Glasgow Outcome Scale were classified as a poor outcome.

Results: During episodes of rCD, BRS decreased significantly compared to baseline (p = 0.027) in patients who had a total duration of rCD episodes of more than 10 hours. During rCD episodes, CA improved slightly in comparison to baseline (p = 0.027). The threshold associated with poor outcome was: rSO₂ < 62% (p = 0.002).

Conclusions: BRS decreased in patients who had a total duration rCD episodes of more than 10 hours within the 5 days of aSAH. These results might partly explain the relationship between lower BRS and worse prognosis.

Keywords: Baroreflex sensitivity; Cerebral autoregulation; Cerebral oxygenation; Subarachnoid haemorrhage.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Autonomic Nervous System
Glasgow Outcome Scale
Humans
Prognosis
Spectroscopy, Near-Infrared
Subarachnoid Hemorrhage* / complications