Autoregulation in paediatric TBI-current evidence and implications for treatment
Autoregulation in paediatric TBI-current evidence and implications for treatment
复制标题
DOI：
10.1007/s00381-017-3523-x
复制
发表时间：
2017-10-01
影响因子：
1.4
通讯作者：
Brady, Ken
中科院分区：
文献类型：
--
作者：
Donnelly, Joseph E.;Young, Adam M. H.;Brady, Ken
急性脑外伤后幸存的儿童有因随后的脑肿胀和继发性损伤而死亡的风险。创伤性脑损伤后，ICU 中严格的生理管理被认为是生存的关键，而脑灌注压是脑损伤后护理的一个重要方面。然而，儿童的最佳脑灌注压目标尚不清楚。自动调节监测已被用来为创伤性脑损伤患者描绘个体化的最佳灌注压。这样做的方法多种多样，令人困惑，并且没有得到普遍验证。在这篇手稿中，我们讨论了自动调节监测的历史，概述和分类了用于测量自动调节的方法，并回顾了用于监测自动调节的方法的可用验证数据。创伤性脑损伤后自动调节受损与不良预后相关。观察数据表明，最佳神经系统结果和生存与自动调节监测定义的最佳灌注压相关。目前尚无随机、对照、介入数据可用于评估儿科创伤性脑损伤后的自动调节监测。
Children who survive acute traumatic brain injury are at risk of death from subsequent brain swelling and secondary injury. Strict physiologic management in the ICU after traumatic brain injury is believed to be key to survival, and cerebral perfusion pressure is a prominent aspect of post brain injury care. However, optimal cerebral perfusion pressure targets for children are not known. Autoregulation monitoring has been used to delineate individualized optimal perfusion pressures for patients with traumatic brain injury. The methods to do so are diverse, confusing, and not universally validated.In this manuscript, we discuss the history of autoregulation monitoring, outline and categorize the methods used to measure autoregulation, and review the available validation data for methods used to monitor autoregulation.Impaired autoregulation after traumatic brain injury is associated with a poor prognosis. Observational data suggests that optimal neurologic outcome and survival are associated with optimal perfusion pressure defined by autoregulation monitoring. No randomized, controlled, interventional data is available to assess autoregulation monitoring after pediatric traumatic brain injury.