# Monitoring Cerebral Autoregulation in Patients Undergoing Traumatic Hip Fracture Surgery to Improve Postoperative Outcomes

> **NIH NIH K76** · JOHNS HOPKINS UNIVERSITY · 2021 · $120,648

## Abstract

PROJECT SUMMARY/ABSTRACT
Background: Surgery for hip fracture can be devastating for older adults, with complications including
delirium, increased risk of dementia, and inability to walk. As an anesthesiologist and clinician-scientist, I have
focused on reducing delirium after surgery. In this proposal, I will build the foundation for a research career
focused on the broader goals of reducing neurocognitive and functional decline after surgery in older adults. I
will specifically focus on the role of optimizing intraoperative cerebral perfusion, because of pilot data
suggesting that reduced cerebral perfusion during surgery is a modifiable risk factor for delirium.
Career Development Plan: I am proposing specific educational goals that address gaps in my current
knowledge. First, I will develop expertise in cerebrovascular physiology and monitoring under the mentorship
of Dr. Koehler, an expert in cerebral blood flow regulation. Second, I will develop expertise in neurocognitive
testing and dementia assessment under the mentorship of Dr. Kamath, a neuropsychologist, and Dr.
Gottesman, an expert in dementia adjudication in the research setting. Third, I will gain expertise in clinical
trials and measuring functional status through the mentorship of Drs. Sieber and Neuman (experts in
perioperative clinical trials in older adults), and Dr. Walston (a geriatrician with expertise in functional status).
Finally, I will develop as a leader through interactions with my mentors, courses, and leadership opportunities.
Research Proposal: During hip fracture surgery, extreme variations in blood pressure are common in older
adults, who are susceptible to cerebral ischemia and vulnerable to consequences of hypotension. However,
there is no standard of care as to what constitutes adequate blood pressure during surgery. Our group has
championed methodology to define optimal blood pressure in individual patients by real-time monitoring of
cerebral autoregulation. Using these methods in cardiac surgery, we have shown that mean arterial pressure
(MAP) below the limits of cerebral autoregulation is associated with postoperative morbidity, and that an
intervention to target intraoperative MAP based on this monitoring may reduce delirium. Although promising,
these results in cardiac surgery may not apply in hip fracture surgery. To address this gap in knowledge, I will
extend these methods to hip fracture surgery patients. I will characterize (a) the extent of, and (b) risk factors
for intraoperative MAP variation above and below the limits of cerebral autoregulation during hip fracture
surgery (Aim 1). I will also examine associations of MAP variation with neurocognitive and functional
outcomes (Aim 2). Based on these results, I will design a pilot feasibility/safety trial to determine whether
targeting MAP within the limits of autoregulation could improve neurocognitive/functional outcomes (Aim 3).
Summary: Promising results from this proposal would support a defin...

## Key facts

- **NIH application ID:** 10399004
- **Project number:** 3K76AG057020-04S1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Charles Hugh Brown
- **Activity code:** K76 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $120,648
- **Award type:** 3
- **Project period:** 2017-08-15 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10399004

## Citation

> US National Institutes of Health, RePORTER application 10399004, Monitoring Cerebral Autoregulation in Patients Undergoing Traumatic Hip Fracture Surgery to Improve Postoperative Outcomes (3K76AG057020-04S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10399004. Licensed CC0.

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