Monitoring of Cerebral Autoregulation

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• 作者：Marek Czosnyka (1)
  Chad Miller (2)
  
  1. Department of Clinical Neurosciences ; Division of Neurosurgery ; University of Cambridge ; Addenbrooke鈥檚 Hospital ; Box 167 ; Cambridge ; CB2 2QQ ; UK
  2. Department of Neurology and Neurosurgery ; Wexner Medical Center at the Ohio State University ; Columbus ; OH ; USA
  
• 关键词：Autoregulation ; Pressure reactivity ; Cerebral perfusion pressure ; Transcranial doppler ultrasound ; Near ; infrared spectroscopy ; Cerebral blood flow
• 刊名：Neurocritical Care
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：21
• 期：2-supp
• 页码：95-102
• 全文大小：196 KB
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  39. Aries, MJ, Czosnyka, M, Budohoski, KP, Steiner, LA, Lavinio, A, Kolias, AG, Hutchinson, PJ, Brady, KM, Menon, DK, Pickard, JD, Smielewski, P (2012) Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med 40: pp. 2456-2463 CrossRef
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  42. Tseng, MY, Czosnyka, M, Richards, H, Pickard, JD, Kirkpatrick, PJ (2005) Effects of acute treatment with pravastatin on cerebral vasospasm, autoregulation, and delayed ischemic deficits after aneurysmal subarachnoid hemorrhage: a phase II randomized placebo-controlled trial. Stroke 36: pp. 1627-1632 CrossRef
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• 刊物主题：Internal Medicine; Neurology;
• 出版者：Springer US
• ISSN：1556-0961

文摘

Pressure autoregulation is an important hemodynamic mechanism that protects the brain against inappropriate fluctuations in cerebral blood flow in the face of changing cerebral perfusion pressure (CPP). Static autoregulation represents how far cerebrovascular resistance changes when CPP varies, and dynamic autoregulation represents how fast these changes happen. Both have been monitored in the setting of neurocritical care to aid prognostication and contribute to individualizing CPP targets in patients. Failure of autoregulation is associated with a worse outcome in various acute neurological diseases. Several studies have used transcranial Doppler ultrasound, intracranial pressure (ICP with vascular reactivity as surrogate measure of autoregulation), and near-infrared spectroscopy to continuously monitor the impact of spontaneous fluctuations in CPP on cerebrovascular physiology and to calculate derived variables of autoregulatory efficiency. Many patients who undergo such monitoring demonstrate a range of CPP in which autoregulatory efficiency is optimal. Management of patients at or near this optimal level of CPP is associated with better outcomes in traumatic brain injury. Many of these studies have utilized the concept of the pressure reactivity index, a correlation coefficient between ICP and mean arterial pressure. While further studies are needed, these data suggest that monitoring of autoregulation could aid prognostication and may help identify optimal CPP levels in individual patients.