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Association of Early Hemodynamic Profile and the Development of Systolic Dysfunction Following Traumatic Brain Injury.

Publication ,  Journal Article
Krishnamoorthy, V; Rowhani-Rahbar, A; Chaikittisilpa, N; Gibbons, EF; Rivara, FP; Temkin, NR; Quistberg, A; Vavilala, MS
Published in: Neurocrit Care
June 2017

BACKGROUND: While systolic dysfunction has been observed following traumatic brain injury (TBI), the relationship between early hemodynamics and the development of systolic dysfunction has not been investigated. Our study aimed to determine the early hemodynamic profile that is associated with the development of systolic dysfunction after TBI. METHODS: We conducted a prospective cohort study among patients under 65 years old without cardiac comorbidities who sustained moderate-severe TBI. Transthoracic echocardiography was performed within the first day after TBI to assess for systolic dysfunction. Hourly systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate, and confounding clinical variables (sedatives, fluid balance, vasopressors, and osmotherapy) were collected during the first 24 h following admission. Multivariable linear mixed models assessed the early hemodynamic profile in patients who developed systolic dysfunction, compared to patients who did not develop systolic dysfunction. RESULTS: Thirty-two patients were included, and 7 (22 %) developed systolic dysfunction after TBI. Patients who developed systolic dysfunction experienced early elevation of SBP, MAP, and heart rate, compared to patients who did not develop systolic dysfunction (p < 0.01 for all comparisons). Patients who developed systolic dysfunction experienced a greater rate of decrease in SBP [-10.2 mmHg (95 % CI -16.1, -4.2)] and MAP [-9.1 mmHg (95 % CI -13.9, -4.3)] over the first day of hospitalization, compared to patients who did not develop systolic dysfunction (p < 0.01 for both comparisons). All sensitivity analyses revealed no substantial changes from the primary model. CONCLUSIONS: Patients who develop systolic dysfunction following TBI have a distinctive hemodynamic profile, with early hypertension and tachycardia, followed by a decrease in blood pressure over the first day after TBI. This profile suggests an early maladaptive catecholamine-excess state as a potential underlying mechanism of TBI-induced systolic dysfunction.

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Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

June 2017

Volume

26

Issue

3

Start / End Page

379 / 387

Location

United States

Related Subject Headings

  • Young Adult
  • Ventricular Dysfunction, Left
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Hypotension
  • Humans
  • Hemodynamics
  • Heart Rate
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Krishnamoorthy, V., Rowhani-Rahbar, A., Chaikittisilpa, N., Gibbons, E. F., Rivara, F. P., Temkin, N. R., … Vavilala, M. S. (2017). Association of Early Hemodynamic Profile and the Development of Systolic Dysfunction Following Traumatic Brain Injury. Neurocrit Care, 26(3), 379–387. https://doi.org/10.1007/s12028-016-0335-x
Krishnamoorthy, Vijay, Ali Rowhani-Rahbar, Nophanan Chaikittisilpa, Edward F. Gibbons, Frederick P. Rivara, Nancy R. Temkin, Alex Quistberg, and Monica S. Vavilala. “Association of Early Hemodynamic Profile and the Development of Systolic Dysfunction Following Traumatic Brain Injury.Neurocrit Care 26, no. 3 (June 2017): 379–87. https://doi.org/10.1007/s12028-016-0335-x.
Krishnamoorthy V, Rowhani-Rahbar A, Chaikittisilpa N, Gibbons EF, Rivara FP, Temkin NR, et al. Association of Early Hemodynamic Profile and the Development of Systolic Dysfunction Following Traumatic Brain Injury. Neurocrit Care. 2017 Jun;26(3):379–87.
Krishnamoorthy, Vijay, et al. “Association of Early Hemodynamic Profile and the Development of Systolic Dysfunction Following Traumatic Brain Injury.Neurocrit Care, vol. 26, no. 3, June 2017, pp. 379–87. Pubmed, doi:10.1007/s12028-016-0335-x.
Krishnamoorthy V, Rowhani-Rahbar A, Chaikittisilpa N, Gibbons EF, Rivara FP, Temkin NR, Quistberg A, Vavilala MS. Association of Early Hemodynamic Profile and the Development of Systolic Dysfunction Following Traumatic Brain Injury. Neurocrit Care. 2017 Jun;26(3):379–387.
Journal cover image

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

June 2017

Volume

26

Issue

3

Start / End Page

379 / 387

Location

United States

Related Subject Headings

  • Young Adult
  • Ventricular Dysfunction, Left
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Hypotension
  • Humans
  • Hemodynamics
  • Heart Rate
  • Female