• Krishma Adatia, Romergryko G Geocadin, Ryan Healy, Wendy Ziai, Luciano Ponce-Mejia, Mirinda Anderson-White, Dhaval Shah, Batya R Radzik, Caitlin Palmisano, Charles W Hogue, Charles Brown, Jose I Suarez, and Lucia Rivera-Lara.
• The Medical School, The University of Sheffield, Sheffield, United Kingdom.
• Crit. Care Med. 2020 Jul 1; 48 (7): 1018-1025.

ObjectivesLateral displacement and impaired cerebral autoregulation are associated with worse outcomes following acute brain injury, but their effect on long-term clinical outcomes remains unclear. We assessed the relationship between lateral displacement, disturbances to cerebral autoregulation, and clinical outcomes in acutely comatose patients.DesignRetrospective analysis of prospectively collected data.SettingNeurocritical care unit of the Johns Hopkins Hospital.PatientsAcutely comatose patients (Glasgow Coma Score ≤ 8).InterventionsNone.Measurements And Main ResultsCerebral oximetry index, derived from near-infrared spectroscopy multimodal monitoring, was used to evaluate cerebral autoregulation. Associations between lateral brain displacement, global cerebral autoregulation, and interhemispheric cerebral autoregulation asymmetry were assessed using mixed random effects models with random intercept. Patients were grouped by functional outcome, determined by the modified Rankin Scale. Associations between outcome group, lateral displacement, and cerebral oximetry index were assessed using multivariate linear regression. Increasing lateral brain displacement was associated with worsening global cerebral autoregulation (p = 0.01 septum; p = 0.05 pineal) and cerebral autoregulation asymmetry (both p < 0.001). Maximum lateral displacement during the first 3 days of coma was significantly different between functional outcome groups at hospital discharge (p = 0.019 pineal; p = 0.008 septum), 3 months (p = 0.026; p = 0.007), 6 months (p = 0.018; p = 0.010), and 12 months (p = 0.022; p = 0.012). Global cerebral oximetry index was associated with functional outcomes at 3 months (p = 0.019) and 6 months (p = 0.013).ConclusionsDuring the first 3 days of acute coma, increasing lateral brain displacement is associated with worsening global cerebral autoregulation and cerebral autoregulation asymmetry, and poor long-term clinical outcomes in acutely comatose patients. The impact of acute interventions on outcome needs to be explored.

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