Cerebrovascular autoregulation in diabetic ketoacidosis: time to go with the (microvascular cerebral blood) flow!
Cerebrovascular autoregulation in diabetic ketoacidosis: time to go with the (microvascular cerebral blood) flow!
复制标题
糖尿病酮症酸中毒的脑血管自动调节：是时候顺应（微血管脑血）流动了！
DOI：
10.1097/pcc.0000000000000204
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Whalen,MichaelJ
中科院分区：
文献类型：
--
作者：
Whalen,MichaelJ
Editorials780 www. pccmjournal. org October 2014• Volume 15• Number 8 the interpretation of TCD data. In the study by Ma et al (1), mean arterial blood pressure remained unchanged and PvCO 2 increased significantly over time, yet middle cerebral artery (MCA) blood velocity remained unchanged between the two measurement periods. Similar results were obtained by Roberts et al (13) who found no change in cerebral blood flow velocity in the MCA despite increasing PaCO2 with treatment of DKA. These findings were interpreted as normal to increased CBF, but in fact these cannot be fully understood without direct quantitation of microvascular CBF. This is more than a theoretical problem because cerebrovascular reactivity index measurements, incorporating ICP waveforms as well as assessment of CBF, may determine optimal CPP and improve outcome in patients with severe traumatic brain injury (14), and the same might be true for patients with DKA and intracranial hypertension as well. Diffuse correlation spectroscopy (DCS) is one technology that shows promise of bedside assessment of microcirculatory cerebral blood flow. DCS measures the temporal intensity fluctuations of photons caused by moving RBCs as light travels from a source emitter, through the brain, and back to photodetectors. The temporal intensity autocorrelation function of the detected light is computed, and correlation diffusion theory is used to obtain tissue blood flow index (cm2/s). Previous studies in brain-injured adults show good correlation between relative CBF changes obtained with DCS and xenon CT (15), and microcirculatory CBF assessed by DCS correlates well with MCA blood velocity assessed by TCD in healthy volunteers (16), suggesting that DCS alone or DCS combined with TCD might be used to better understand cerebrovascular autoregulation in DKA. If so, such technology might bring us one step closer to noninvasive real-time monitoring of microvascular CBF reactivity in children with DKA, as well as other CNS diseases and injuries for which CBF measurements outside the PICU may not be safe or feasible.
