Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma

Howells, Tim; Elf, Kristin; Jones, Patricia A.; Ronne-Engström, Elisabeth; Piper, Ian; Nilsson, Pelle; Andrews, Peter; Enblad, Per

doi:10.3171/jns.2005.102.2.0311

Cited by 214 publications

(126 citation statements)

References 20 publications

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“…Patients with impaired autoregulation, with a PRx slope > 0.13, may have a better outcome with hypotensive ICP-oriented therapy, such as the Lund protocol. 22 As mentioned above, this observation has been incorporated into the most recent guidelines for the management of severe TBI. 7,8 The normal 100 mm Hg-wide sROR range (50-150 mm Hg) can be reduced to a 10 mm Hg-wide autoregulation range in severe TBI.…”

Section: Diagnosis Of Abnormal Cerebral Autoregulation and Its Role Imentioning

confidence: 99%

Cerebral pressure autoregulation in traumatic brain injury

Rangel-Castilla

Gasco

Nauta

et al. 2008

FOC

179

104

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An understanding of normal cerebral autoregulation and its response to pathological derangements is helpful in the diagnosis, monitoring, management, and prognosis of severe traumatic brain injury (TBI). Pressure autoregulation is the most common approach in testing the effects of mean arterial blood pressure on cerebral blood flow. A gold standard for measuring cerebral pressure autoregulation is not available, and the literature shows considerable disparity in methods. This fact is not surprising given that cerebral autoregulation is more a concept than a physically measurable entity. Alterations in cerebral autoregulation can vary from patient to patient and over time and are critical during the first 4–5 days after injury. An assessment of cerebral autoregulation as part of bedside neuromonitoring in the neurointensive care unit can allow the individualized treatment of secondary injury in a patient with severe TBI. The assessment of cerebral autoregulation is best achieved with dynamic autoregulation methods. Hyperventilation, hyperoxia, nitric oxide and its derivates, and erythropoietin are some of the therapies that can be helpful in managing cerebral autoregulation. In this review the authors summarize the most important points related to cerebral pressure autoregulation in TBI as applied in clinical practice, based on the literature as well as their own experience.

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Section: Diagnosis Of Abnormal Cerebral Autoregulation and Its Role Imentioning

confidence: 99%

Cerebral pressure autoregulation in traumatic brain injury

Rangel-Castilla

Gasco

Nauta

et al. 2008

FOC

179

104

View full text Add to dashboard Cite

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“…The most readily available measure is the pressure reactivity index (PRx), which is a moving correlation coefficient calculated from measurements of ICP and MAP (Czosnyka et al 1998). Centers that employ this measurement have reported that patients with intact autoregulation (PRx is low) have improved outcomes when managed according to a CPP guided paradigm, whereas those with impaired autoregulation (PRx is elevated) benefit from an ICP targeted strategy (Howells et al 2005). Clearly, this observation warrants additional study.…”

Section: Cerebral Edema Intracranial Hypertension and Cerebral Perfumentioning

confidence: 99%

“…However, the physiological and pathophysiological significance of these phases has been debated, and significant regional variation of cerebral perfusion is present (Wintermark et al 2004). As discussed previously, cerebral perfusion can be significantly affected by systemic factors that impact the MAP and the CPP; the magnitude of this effect is dependent upon the individual's autoregulatory status (Czosnyka et al 1998;Howells et al 2005). Furthermore, the reports of the incidence and significance of cerebral vasospasm after trauma are variable, and likely are affected by the mechanism of injury (Martin et al 1997;Zubkov et al 2000).…”

Section: Cerebral Blood Flow and Brain Tissue Oxygenationmentioning

confidence: 99%

Traumatic Brain Injury - Acute Care

Hays¹,

Varma²

2012

Brain Injury - Pathogenesis, Monitoring, Recovery and Management

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“…Of these models, the pressure reactivity index (PRx) is the most studied and uses the naturally occurring slow oscillations of ABF to estimate cerebrovascular reactivity. This is a moving correlation coefficient between 40 consecutive values of ABP and ICP averaged over 5 s. Studies [21,22] have established a correlation between PRx values of >0.2 for more than 6 h and a fatal outcome. Although it has its limitations, it has been found to be a reliable index of cerebral autoregulation validated by TCD and PET and can be used to guide therapy with the calculation of an optimal CPP or an individualized or patient-specific ICP.…”

Section: Pressure Reactivity Indexmentioning

confidence: 99%

The Role of Invasive Monitoring in Traumatic Brain Injury

Carandang

2015

Curr Trauma Rep

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Severe traumatic brain injury is a complex disease that involves physical injury and distortion of tissues and cell membranes, gross hemodynamic changes including loss of autoregulation, cerebral edema and tissue shifts, changes in pressure and perfusion and multiple secondary cellular processes including electrolyte fluxes, inflammatory mediator release, neurotransmitter mediated excitotoxicity, apoptosis, mitochondrial dysfunction, and alterations in cellular metabolism. The optimal treatment of these patients who have severe neurological dysfunction or require sedation that compromises neurological functional assessment by physical examination requires the monitoring and management of multiple aspects of brain physiology including pressure, perfusion, oxygenation, cellular metabolism, and electrical activity. Invasive monitoring techniques, while still in various stages of development, can and will provide real-time trackable data that informs the management of these patients as well as contributes to our understanding of the pathophysiological processes that contribute to it.

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Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma

Cited by 214 publications

References 20 publications

Cerebral pressure autoregulation in traumatic brain injury

Cerebral pressure autoregulation in traumatic brain injury

Traumatic Brain Injury - Acute Care

The Role of Invasive Monitoring in Traumatic Brain Injury

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