Cerebral pressure autoregulation in traumatic brain injury

Neurosurgical Focus - Tập 25 Số 4 - Trang E7 - 2008
Leonardo Rangel-Castilla1, Jaime Gasco2, Haring J. W. Nauta2, David O. Okonkwo3, Claudia S. Robertson4
1Division of Neurosurgery, University of Texas Medical Branch, Galveston, Texas 77555, USA.
21Division of Neurosurgery, University of Texas Medical Branch, Galveston;
32Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
43Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and

Tóm tắt

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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Tài liệu tham khảo

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Neurosurgical Focus

Tập 25 Số 4

E7

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