Observational studyPediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2014
Transcranial Doppler-based assessment of cerebral autoregulation in critically ill children during diabetic ketoacidosis treatment.
Observational study in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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16 citing papers in PubMed, 27 citations in OpenAlex.
- Hypertension during Diabetic Ketoacidosis in Children.The Journal of pediatrics · 2020Trial
- Clinical Applications of Point-of-Care and Diagnostic Transcranial Doppler in the Pediatric Acute Care Setting: A Scoping Review.Neurocritical care · 2026Article
- Cerebral autoregulation in pediatric and neonatal intensive care: A scoping review.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2024Article
- Experience with clinical cerebral autoregulation testing in children hospitalized with traumatic brain injury: Translating research to bedside.Frontiers in pediatrics · 2022Article
- Clinical applications of transcranial Doppler in non-trauma critically ill children: a scoping review.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2021Article
- Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric Intensive Care Unit: A Multidisciplinary Expert Consensus Statement.Journal of pediatric intensive care · 2021Article
- Brain injury in children with diabetic ketoacidosis: Review of the literature and a proposed pathophysiologic pathway for the development of cerebral edema.Pediatric diabetes · 2021Review
- Transcranial Doppler Use in Non-traumatic Critically Ill Children: A Multicentre Descriptive Study.Frontiers in pediatrics · 2021Article
- The authors reply.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2019Article
- The Need to Understand Brain Health and Improve Brain Outcomes for Children and Adolescents Warrants Adoption of a More Proactive Approach to Brain Monitoring.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2019Article
- Genetic drivers of cerebral blood flow dysfunction in TBI: a speculative synthesis.Nature reviews. Neurology · 2019Review
- The role of KActa pharmacologica Sinica · 2018Review
- Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus.European endocrinology · 2018Article
- Early changes in cerebral autoregulation among youth hospitalized after sports-related traumatic brain injury.Brain injury · 2018Article
- Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study.The western journal of emergency medicine · 2016Article
- Cerebrovascular autoregulation in diabetic ketoacidosis: time to go with the (microvascular cerebral blood) flow!Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2014Article
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7 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesImpaired cerebral autoregulation may be associated with poor outcome in diabetic ketoacidosis. We examined change in cerebral autoregulation during diabetic ketoacidosis treatment.
designProspective observational cohort study.
settingTertiary care children's hospital. PATIENTS/SUBJECTS: Children admitted to the ICU with diabetic ketoacidosis (venous pH < 7.3, glucose > 300 mg/dL, HCO3 < 15 mEq/L, and ketonuria) constituted cases, and children with type I diabetes without diabetic ketoacidosis constituted controls.
interventionsNone. MEASUREMENTS AND MAIN
resultsBetween 2005 and 2009, 32 cases and 50 controls were enrolled. Transcranial Doppler ultrasonography was used to measure middle cerebral artery flow velocities, and cerebral autoregulation testing was achieved via tilt-table testing. Cases underwent two and controls underwent one cerebral autoregulation test. Cerebral autoregulation was quantified by the autoregulatory index (autoregulatory index < 0.4 = impaired and autoregulatory index 0.4-1.0 = intact autoregulation). The first autoregulation test was obtained early (time 1, 12-24 hr; median [interquartile range], 8 hr [5-18 hr]) during diabetic ketoacidosis treatment, and a second autoregulation test was obtained during recovery (time 2, 36-72 hr; median [ interquartile range], 46 hr [40-59 hr]) from time 0 (defined as time of insulin start). Cases had lower autoregulatory index at time 1 than time 2 (p < 0.001) as well lower autoregulatory index than control subjects (p < 0.001). Cerebral autoregulation was impaired in 40% (n = 13) of cases at time 1 and in 6% (n = 2) of cases at time 2. Five cases (17%) showed persistent impairment of cerebral autoregulation between times 1 and 2 of treatment. All control subjects had intact cerebral autoregulation.
conclusionsImpaired cerebral autoregulation was common early during diabetic ketoacidosis treatment. Although the majority improved during diabetic ketoacidosis treatment, 17% of subjects had impairment between 36 and 72 hours after start of insulin therapy. The observed impaired cerebral autoregulation appears specific to the diabetic ketoacidosis process in patients with type I diabetes.
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