Cerebral Autoregulation Monitoring in Traumatic Brain Injury: An Overview of Recent Advances in Personalized Medicine

Abstract

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Secondary hyperperfusion injury following surgical evacuation for acute isolated epidural hematoma with concurrent cerebral herniation

“…Compared with the aforementioned uncontrollable influencing factors, we first notice that the amplitude of instant change in CBF reperfusion is controllable to some extent. It is also an important factor affecting CBF reperfusion in patients with abnormal cerebral vascular autoregulation (27)(28)(29). Tamaki et al (30) found that the quick evacuation of the hematoma could decrease the intracranial pressure sharply and, at the same time, trigger a severe aggravation of hemodynamic change, thus worsening the overload injury to the decompensated cerebral vessels.…”

Multimodal and autoregulation monitoring in the neurointensive care unit

“…Early studies evaluating CA capacity in ABI focused on intermittent methods for CA determination including various neuroimaging modalities such as positron emission tomography (PET) and computed tomographic xenon (XE-CT) as well as indirect CBF estimation with transcranial doppler (TCD) in response to alterations in MAP either with vasopressors or non-invasively with techniques such as thigh-cuff deflation and orthostatic hypotension provocation ( 10 , 33 ). More recently, novel methods have been developed for continuous assessment of CA indices based on CBF responses to spontaneous changes in MAP or cerebral perfusion pressure CPP and are outlined in Table 1 ( 44 ).…”

“…This multifaceted approach has begun to reshape the landscape of neurocritical care by moving away from standardized “one size fits all” treatment strategies to individualized precision medicine; however, questions still exist including how to best integrate and interpret the high dimensionality of signals and whether such an approach will result in improved patient outcomes ( 3 , 9 ). Furthermore, when interpreting monitoring data, it is important to recognize potential limitations of each modality and specific characteristics including whether it provides continuous or intermittent assessment as well as if the device is measuring focal or global cerebral parameters ( 10 , 11 ). Common neuromonitoring tools employed in the neurologic intensive care unit (ICU) are highlighted in Figure 1 .…”

Beyond intracranial pressure: monitoring cerebral perfusion and autoregulation in severe traumatic brain injury

“…PRx has been demonstrated to be capable of adequately predicting the lower limit of cerebral autoregulation (LLA), but the upper limit of cerebral autoregulation (ULA) is not easily predictable [22,23]. Other tools also have had difficulties to predict the ULA, and it even might be that there is no strict ULA, and cerebral autoregulation is better in compensating for hypotension than for hypertension [24 ▪▪ ]. In retrospective series, it was found that when PRx is plotted against its corresponding CPP, in 60–70% of patients, this leads to a U-shaped curve, in which the lowest (i.e.…”

“…As they all measure a different parameter, they are not quite redeemable. Because the benefit of treatment protocols based on these metrics has not been unequivocally demonstrated in large prospective patient trials, their use cannot be recommended for clinical use so far [24 ▪▪ ,30].…”