Change in cerebral autoregulation as a function of time in children after severe traumatic brain injury: a case series

Objective The objective of this study was to describe changes in cerebral autoregulation after severe pediatric traumatic brain injury (TBI). Materials and methods Two cerebral autoregulation tests were performed during the first 10 days after severe TBI in children <16 years. Cerebral autoregulation was quantified using the mean autoregulatory index (mARI). Results Nine (five males/four females) children (10 ± 5 years) with severe (admission Glasgow Coma Scale (GCS), 5 ± 2) TBI were enrolled. Thirty (3/9) percent of initial exams revealed impaired cerebral autoregulation; all three had returned to intact cerebral autoregulation on second exam. However, in three of nine (33%) patients, cerebral autoregulation worsened on second exam. Of the factors examined, worsening mARI on second exam was associated with worsening head computed tomography (CT) lesion. Conclusions Cerebral autoregulation often changed and worsened during the first 9 days after severe pediatric TBI. Worsening cerebral autoregulation may mirror worsening TBI.