Cerebral Blood Flow Autoregulation in Sepsis for the Intensivist: Why Its Monitoring May Be the Future of Individualized Care.
Cerebral Blood Flow Autoregulation in Sepsis for the Intensivist: Why Its Monitoring May Be the Future of Individualized Care.
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DOI：
10.1177/0885066616673973
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发表时间：
2018-03
影响因子：
3.1
通讯作者：
Hogue CW
中科院分区：
文献类型：
--
作者：
Goodson CM;Rosenblatt K;Rivera-Lara L;Nyquist P;Hogue CW
脑血流量（CBF）自动调节在一定范围的血压（BP）内维持一致的血流。脓毒症是全身性低血压和脑功能障碍的常见原因。脓毒症中的BP管理指南是基于CBF自动调节的历史概念，现在随着更精确的测量技术的可用性而发展。在这篇文章中，我们提供了一个叙述性的审查方法，监测脑血流量自动调节，脓毒症的大脑影响，以及目前的知识，脑血流量自动调节脓毒症。目前脓毒症患者的血压管理指南是基于维持平均动脉压（MAP）高于CBF自动调节下限的目标。床边工具现在可用于连续监测CBF自动调节。这些数据表明，根据CBF自动调节监测确定的个体BP目标比先前预期的更易变。例如，在接受心肺转流心脏手术的患者中，自动调节的下限在40至90 mm Hg的MAP之间变化。脓毒症中CBF自动调节的研究表明，患者经常表现出受损的CBF自动调节，可能是由于BP低于自动调节的下限，特别是在早期脓毒症或脓毒症相关脑病中。这表明，目前关于脓毒症BP管理的共识指南可能会使一些患者暴露于脑灌注不足和脑灌注过度，可能导致脑实质损伤。未来使用新技术研究和临床监测CBF自动调节可以深入了解脓毒症的脑病理生理学，并提供更精确的治疗方法，可以改善脓毒症幸存者的功能和认知结果。
Cerebral blood flow (CBF) autoregulation maintains consistent blood flow across a range of blood pressures (BPs). Sepsis is a common cause of systemic hypotension and cerebral dysfunction. Guidelines for BP management in sepsis are based on historical concepts of CBF autoregulation that have now evolved with the availability of more precise technology for its measurement. In this article, we provide a narrative review of methods of monitoring CBF autoregulation, the cerebral effects of sepsis, and the current knowledge of CBF autoregulation in sepsis. Current guidelines for BP management in sepsis are based on a goal of maintaining mean arterial pressure (MAP) above the lower limit of CBF autoregulation. Bedside tools are now available to monitor CBF autoregulation continuously. These data reveal that individual BP goals determined from CBF autoregulation monitoring are more variable than previously expected. In patients undergoing cardiac surgery with cardiopulmonary bypass, for example, the lower limit of autoregulation varied between a MAP of 40 to 90 mm Hg. Studies of CBF autoregulation in sepsis suggest patients frequently manifest impaired CBF autoregulation, possibly a result of BP below the lower limit of autoregulation, particularly in early sepsis or with sepsis-associated encephalopathy. This suggests that the present consensus guidelines for BP management in sepsis may expose some patients to both cerebral hypoperfusion and cerebral hyperperfusion, potentially resulting in damage to brain parenchyma. The future use of novel techniques to study and clinically monitor CBF autoregulation could provide insight into the cerebral pathophysiology of sepsis and offer more precise treatments that may improve functional and cognitive outcomes for survivors of sepsis.
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幸存的败血症运动：严重败血症和化粪池冲击管理的国际指南，2012年。
影响因子：
38.9
作者：
Dellinger RP;Levy MM;Rhodes A;Annane D;Gerlach H;Opal SM;Sevransky JE;Sprung CL;Douglas IS;Jaeschke R;Osborn TM;Nunnally ME;Townsend SR;Reinhart K;Kleinpell RM;Angus DC;Deutschman CS;Machado FR;Rubenfeld GD;Webb S;Beale RJ;Vincent JL;Moreno R;Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
通讯作者：
Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
影响因子：
2.5
作者：
Dagal, Armagan;Lam, Arthur M.
通讯作者：
Lam, Arthur M.
影响因子：
8.3
作者：
BISHOP, CCR;POWELL, S;BROWSE, NL
通讯作者：
BROWSE, NL
影响因子：
3.7
作者：
Azabou E;Magalhaes E;Braconnier A;Yahiaoui L;Moneger G;Heming N;Annane D;Mantz J;Chrétien F;Durand MC;Lofaso F;Porcher R;Sharshar T;Groupe d'Explorations Neurologiques en Réanimation (GENER)
通讯作者：
Groupe d'Explorations Neurologiques en Réanimation (GENER)
影响因子：
10.7
作者：
Bowie, RA;O'Connor, PJ;Mahajan, RP
通讯作者：
Mahajan, RP