期刊
ACTA NEUROCHIRURGICA
卷 162, 期 7, 页码 1647-1662出版社
SPRINGER WIEN
DOI: 10.1007/s00701-020-04378-7
关键词
Autoregulation; Cerebrovascular reactivity; ICP measures; Systematic review
资金
- Manitoba Public Insurance (MPI) Neurscience/TBI Research Endowment
- United States National Institutes of Health (NIH) through the National Institute of Neurological Disorders and Stroke (NINDS)
- Canadian Institutes of Health Research (CIHR)
- Canadian Foundation for Innovation (CFI)
- University of Manitoba VPRI Research Investment Fund (RIF)
- University of Manitoba Rudy Falk Clinician-Scientist Professorship
- Health Sciences Centre Foundation Winnipeg
- Svenska Sallskapet for Medicinsk Forskning (SSMF)
- Hjarnfonden (Mattsons Stiftelse)
- Region Stockholm Funding (ALF)
- Finska Lakaresallskapet
- Medicinska Understodsforeningen Liv Halsa
- Clinician Investigator program at the University of Manitoba
- Department of Surgery GFT Surgeons Research Grant from clinical earnings of GFT surgeons at the University of Manitoba, Winnipeg, Manitoba, Canada
Background Pressure reactivity index (PRx) has emerged as a means to continuously monitor cerebrovascular reactivity in traumatic brain injury (TBI). However, other intracranial pressure (ICP)-based continuous metrics exist, and may have advantages over PRx. The goal of this study was to perform a scoping overview of the literature on non-PRx ICP-based continuous cerebrovascular reactivity metrics in adult TBI. Methods We searched MEDLINE, BIOSIS, EMBASE, Global Health, SCOPUS, and Cochrane Library from inception to December 2019. Using a two-stage filtering of title/abstract, and then full manuscript, we identified pertinent articles. Data was abstracted to tables and each technique summarized, including pulse amplitude index (PAx), correlation between pulse amplitude of ICP and cerebral perfusion pressure (RAC), PRx(55-15), and low-resolution metrics LAx and L-PRx. Results A total of 23 articles met the inclusion criteria, with the vast majority being retrospective in nature and based out of European centers. Sixteen articles focused on high-resolution metrics PAx, RAC, and PRx(55-15), with 6 articles focusing on LAx and L-PRx. PAx may have a role in low ICP situations, where it appears to perform superior to PRx. RAC displays similar behavior to PRx, with a trend to stronger associations with favorable/unfavorable outcome at 6 months, and stronger parabolic relationship with CPP. PRx(55-15) provides a focused assessment on the vasogenic frequency range associated with cerebral autoregulation, with preliminary data supporting a strong association with outcome in TBI. LAx and L-PRx display varying associations with 6-month outcome in TBI, depending on the window length of calculation, with shorter windows demonstrating stronger correlations with classical PRx. Conclusions Non-PRx continuous ICP-based cerebrovascular reactivity metrics can be split into high-resolution and low-resolution measures. High-resolution indices include PAx, RAC, and PRx(55-15), while low-resolution indices include L-PRx and LAx. The true role for these metrics beyond classic PRx remains unclear. Each displays situations where it may prove superior over PRx, given limitations with this currently widely accepted measure. Much future investigation into each of these alternative metrics is required prior to adoption into the clinical monitoring armamentarium in adult TBI.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据