Implications of neurophysiological parameters in persons with severe brain injury with respect to improved patient outcomes: A retrospective review

Bowles, Alfred P.; Pasierb, Lisa; Simunich, Thomas; Updyke, Monica

doi:10.3109/02699052.2012.694558

Cited by 9 publications

(2 citation statements)

References 9 publications

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“…2 In injured brains, this autoregulation can be impaired, and observational studies have demonstrated a relationship between loss of autoregulation and poor outcome. [3][4][5][6] In patients with poor intracranial compliance, changes in cerebral blood volume, as dictated by vessel diameter, are expressed as variations in intracranial pressure (ICP). By analysing the dynamic relationship between mean arterial pressure (MAP) and ICP over a given time period (the length may be chosen arbitrary, but it should be substantially longer than respiratory and pulse period), an appreciation of cerebrovascular pressure reactivity can be gained, providing information about the integrity of autoregulation.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Perfusion Pressure Targets Individualized to Pressure-Reactivity Index in Moderate to Severe Traumatic Brain Injury: A Systematic Review

Needham

McFadyen

Newcombe

et al. 2017

Journal of Neurotrauma

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Traumatic brain injury (TBI) frequently triggers a disruption of cerebral autoregulation. The cerebral perfusion pressure (CPP) at which autoregulation is optimal ("CPPopt") varies between individuals, and can be calculated based on fluctuations between arterial blood pressure and intracranial pressure. This review assesses the effect of individualizing CPP targets to pressure reactivity index (a measure of autoregulation) in patients with TBI. Cochrane Central Register of Controlled Trials, MEDLINE®, Embase, and Cumulative Index of Nursing and Allied Health Literature were searched in March 2015 for studies assessing the effect of targeting CPPopt in TBI. We included all studies that assessed the impact of targeting CPPopt on outcomes including mortality, neurological outcome, and physiological changes. Risk of bias was assessed using the RTI Item Bank and evidence quality was considered using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Eight cohort studies (based on six distinct data sets) assessing the association between CPPopt and mortality, Glasgow Outcome Scale and physiological measures in TBI were included. The quality of evidence was deemed very low based on the GRADE criteria. Although the data suggest an association between variation from CPPopt and poor clinical outcome at 6 months, the quality of evidence prevents firm conclusions, particularly regarding causality, from being drawn. Available data suggest that targeting CPPopt might represent a technique to improve outcomes following TBI, but currently there is insufficient high-quality data to support a recommendation for use in clinical practice. Further prospective, randomized controlled studies should be undertaken to clarify its role in the acute management of TBI.

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Section: Introductionmentioning

confidence: 99%

Cerebral Perfusion Pressure Targets Individualized to Pressure-Reactivity Index in Moderate to Severe Traumatic Brain Injury: A Systematic Review

Needham

McFadyen

Newcombe

et al. 2017

Journal of Neurotrauma

View full text Add to dashboard Cite

show abstract

“…This is supported by an analysis of 103 TBI patients in which the authors conclude that "…Brain hypoxia is associated with poor short-term outcome after severe traumatic brain injury independently of elevated ICP, low CPP, and injury severity. Other than ICP and CPP, pbtO2 is an independent factor for outcome [266]. One paper has pointed out that initial radiographic and clinical scales, which are correlated with patient outcome after TBI, are not associated with subsequent ICP or pbtO2 [267].…”

Section: Definition Of Normal and Pathological Values -A Complex Taskmentioning

confidence: 99%

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Lang

Jaeger²

2013

TOCCMJ

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This review has been compiled to assess publications related to the clinical application of direct cerebral tissue oxygenation (pbtO2) monitoring published in international, peer-reviewed scientific journals, or major meeting reports published as journal supplements. Its goal was to extract relevant, i.e. positive and negative, information on indications, clinical application, safety issues and impact on clinical situations, as well as treatment strategies in neurosurgery, neurosurgical anaesthesiology, neurosurgical intensive care, neurology, and related specialties. For completeness' sake it also presents related basic science research and case reports. This review is an update of its previous edition published elsewhere in 2007. This review reflects publications from 2004 to 2012. Only relevant publications prior to 2004, which explicitly addressed or systematically examined the above issues, are included in this review and are listed in the reference section. Based on 349 citations it is the most comprehensive review available on direct cerebral oxygen monitoring to this date.Keywords: Review, cerebral oxygenation, raumedic, licox, neurotrend, cerebral partial pressure of oxygen, brain tissue oxygenation. METHODSThis review is based on a systematic "Medline" literature search using the following search terms: licox, neurotrend, neurovent, raumedic, brain tissue oxygen, brain tissue oxygenation, cerebral oxygenation, cerebral tissue oxygen, cerebral partial pressure of oxygen, btO2, ptiO2, pti(O)2, ptiO(2), pbrO2, PBr(O2), P(bt)O(2), P(br)O(2), PbrO(2), BTpO2, tP(O2), PbO2, PbtO2, Pbto, PbtO(2).Only few publications were not retrieved using this technique. They were, however, identified through personal communication with scientists in the field, meeting proceedings and reviewer assignments. This strategy provided sufficient certainty that relevant papers have not been missed. Unpublished meeting abstracts and published conference proceedings were excluded for this review expect for few which provided comparative studies between different probes. To address relevant matters, related to specific pbtO2 issues, selected non-peer reviewed papers published in supplements were also used only when no other peer-reviewed information was available. RESULTSThis review is based on a previous review [1]. It is currently based on 349 papers, 274 more papers compared to its previous version in 2007, which warrants the update.

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Vascular Responses in Rodent Models of Traumatic Brain Injury

Wang

Liao

et al. 2013

Vascular Mechanisms in CNS Trauma

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Implications of neurophysiological parameters in persons with severe brain injury with respect to improved patient outcomes: A retrospective review

Abstract: Improved autoregulation was associated with PRx values near zero. Controlling those parameters that affect PRx, namely MAP, ICP and CPP and more importantly cerebral oxygen perfusion (COP), would likely increase the probability of a better outcome while guarding against secondary insult.

Cited by 9 publications

References 9 publications

Cerebral Perfusion Pressure Targets Individualized to Pressure-Reactivity Index in Moderate to Severe Traumatic Brain Injury: A Systematic Review

Cerebral Perfusion Pressure Targets Individualized to Pressure-Reactivity Index in Moderate to Severe Traumatic Brain Injury: A Systematic Review

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Vascular Responses in Rodent Models of Traumatic Brain Injury

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