by Adatia, Krishma;
Geocadin, Romergryko G.; Healy, Ryan; Ziai, Wendy; Ponce-Mejia, Luciano;
Anderson-White, Mirinda; Shah, Dhaval; Radzik, Batya R.; Palmisano, Caitlin;
Hogue, Charles W.; Brown, Charles; Rivera-Lara, Lucia
Objectives: Impaired
cerebral autoregulation following neurologic injury is a predictor of poor
clinical outcome. We aimed to assess the relationship between body temperature
and cerebral autoregulation in comatose patients. Design: Retrospective
analysis of prospectively collected data. Setting: Neurocritical care unit of
the Johns Hopkins Hospital. Patients: Eighty-five acutely comatose patients
(Glasgow Coma Scale score of ≤ 8) admitted between 2013 and 2017.
Interventions: None. Measurement and Main Results: Cerebral autoregulation was
monitored using multimodal monitoring with near-infrared spectroscopy–derived cerebral
oximetry index. Cerebral oximetry index was calculated as a Pearson correlation
coefficient between low-frequency changes in regional cerebral oxygenation
saturation and mean arterial pressure. Patients were initially analyzed
together, then stratified by temperature pattern over the monitoring period: no
change (< 1°C difference between highest and lowest temperatures; n = 11),
increasing (≥ 1°C; n = 9), decreasing (≥ 1°C; n = 9), and fluctuating (≥ 1°C
difference but no sustained direction of change; n = 56). Mixed random effects
models with random intercept and multivariable logistic regression analysis
were used to assess the association between hourly temperature and cerebral
oximetry index, as well as between temperature and clinical outcomes. Cerebral
oximetry index showed a positive linear relationship with temperature (β =
0.04 ± 0.10; p = 0.29). In patients where a continual increase or decrease in
temperature was seen during the monitoring period, every 1°C change in
temperature resulted in a cerebral oximetry index change in the same direction
by 0.04 ± 0.01 (p < 0.001) and 0.02 ± 0.01 (p = 0.12), respectively, after
adjusting for PaCO2, hemoglobin, mean arterial pressure, vasopressor and
sedation use, and temperature probe location. There was no significant
difference in mortality or poor outcome (modified Rankin Scale score of 4–6)
between temperature pattern groups at discharge, 3, or 6 months. Conclusions:
In acute coma patients, increasing body temperature is associated with
worsening cerebral autoregulation as measured by cerebral oximetry index. More
studies are needed to clarify the impact of increasing temperature on cerebral
autoregulation in patients with acute brain injury.
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