Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Crit Care Explor. 2024 Apr 26;6(5):e1083. doi: 10.1097/CCE.0000000000001083. eCollection 2024 May.
This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP.
A single-center prospective cohort study.
The study was conducted in a cardiac center over 4 years (2019-2022).
Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded.
Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24-48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured.
TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10-16 mm Hg) to 15 mm Hg (IQR, 12-21 mm Hg) postoperatively ( = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14-30 mm Hg) to 28 mm Hg (IQR, 22-38 mm Hg) postoperatively ( = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar.
Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances.
本前瞻性队列研究旨在探讨行 Glenn 手术的先天性心脏病婴儿颅内压 (ICP) 和脑血流动力学的变化，重点关注上腔静脉压与估计 ICP 的关系。
单中心前瞻性队列研究。
该研究在一家心脏中心进行，历时 4 年（2019-2022 年）。
27 例先天性心脏病患儿拟行 Glenn 手术，记录详细的患者人口统计学和主要诊断。
经颅多普勒 (TCD) 超声检查在三个时间点进行：基线（术前）、术后通气时（术后 24-48 小时内）和出院时。测量 TCD 参数、血压和肺动脉压。
TCD 参数包括收缩期血流速度、舒张期血流速度 (dFV)、平均血流速度 (mFV)、搏动指数 (PI) 和阻力指数。采用既定公式计算估计 ICP 和脑灌注压 (CPP)。术后估计 ICP 从 11mmHg（四分位距 [IQR]，10-16mmHg）显著增加至 15mmHg（IQR，12-21mmHg）（ = 0.002），CPP 有从 22mmHg（IQR，14-30mmHg）增加至 28mmHg（IQR，22-38mmHg）的趋势（ = 0.1）。TCD 指数反映了脑血流动力学的变化，包括 dFV 和 mFV 降低以及 PI 增加。有创通气和拔管后的颅内血流动力学相似。
Glenn 手术显著增加了估计 ICP，同时 CPP 有升高趋势。这些发现强调了静脉压和行 Glenn 手术的婴儿脑血流动力学之间复杂的相互作用。它们还突出了在这些情况下维持稳定脑灌注的脑血管自动调节的显著复杂性。
