Effect of Targeted Temperature Management on Cerebral Autoregulation in Patients With Neurocritical Diseases
Effect of Targeted Temperature Management on Cerebral Autoregulation in Patients With Neurocritical Diseases
Change and effect of cerebral autoregulation during targeted temperature management in
 neurocritical patients
Cerebral autoregulation (CA) is the ability of cerebral vascular system to contract or
 diastole with the change of perfusion pressure, and to maintain the stability of cerebral
 blood flow. It has been found that there are different degrees of CA damage in patients with
 traumatic brain injury, ischemic stroke, hemorrhagic stroke, aneurysmal subarachnoid
 hemorrhage, ischemic hypoxic encephalopathy and sepsis. At the same time, studies have shown
 that CA damage or loss is related to brain dysfunction and poor prognosis in patients with
 neurocritical diseases. Therefore, early assessment and intervention of CA can help identify
 individuals with high risk of complications and improve outcome.

 Targeted temperature management (TTM) is a kind of body temperature management started when
 the core temperature of patients is higher than 37.5 ℃, including achieve hypothermia
 (TTMhypo) and maintain normal temperature (TTMnorm). TTMhypo has been widely considered as
 one of the neuroprotective therapies for a variety of brain diseases and injuries, including
 ischemic stroke, traumatic brain injury, hypoxic brain injury caused by out-of-hospital
 cardiac arrest and neonatal hypoxic ischemic encephalopathy. Its neuroprotective effects in
 reducing brain edema, reducing intracranial pressure, reducing brain metabolism and
 inhibiting apoptosis have been recognized. However, the existing studies mainly focus on the
 effect of TTMhypo on the mortality and neurological outcome of patients with severe
 neurological diseases in ICU. There is no large clinical study on the effect of targeted
 temperature management (TTM) on cerebral autoregulation in patients with severe neurological
 diseases. Due to the controversy of TTMhypo on mortality and neurological outcome, this study
 aime to reduce the patient's core temperature to normal. Patients with severe neurological
 disorders who still had cerebral autoregulation dysfunction, had fever, and needed to reduce
 the core temperature to normal. Therefore, the effect of TTMnorm on cerebral autoregulation
 before and during cooling was observed.The main measures were the THRR, Mx and TOx during
 cooling.
Inclusion Criteria:

 - Aneurysmal subarachnoid hemorrhage (aSAH), Traumatic brain injury (TBI), Acute ischemic
 stroke (AIS), Intracerebral hemorrhage (ICH), Ischemic hypoxic encephalopathy (HIE),
 sepsis-associated encephalopathy (SAE) who need to reduce the core temperature to normal.

 Exclusion Criteria:

 -  Age < 18 years old;

 -  Pregnancy;

 -  The temporal window was limited and the image could not be obtained;

 -  Patients with bradycardia induced by common carotid artery compression and intolerant
 of THRT

 -  Patients with severe carotid artery disease;

 -  Uncorrected severe coagulation disorders and active bleeding;

 -  Patients without informed consent;

 -  Patients who had been treated with hypothermia before inclusion