Determining the Upper and Lower Limits of Cerebral Autoregulation With Cerebral Oximetry Autoregulation Curves: A Case Series.
Determining the Upper and Lower Limits of Cerebral Autoregulation With Cerebral Oximetry Autoregulation Curves: A Case Series.
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DOI：
10.1097/ccm.0000000000003012
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发表时间：
2018-05
影响因子：
8.8
通讯作者：
Mirski MA
中科院分区：
文献类型：
--
作者：
Rivera-Lara L;Zorrilla-Vaca A;Healy RJ;Ziai W;Hogue C;Geocadin R;Radzik B;Palmisano C;Mirski MA
重症监护指南建议危重患者的平均动脉压(MAP)为单一目标值。然而，越来越多的关于脑自动调节(CA)的证据挑战了这一概念，并支持个体化MAP靶点以防止脑和肾脏的低或高灌流。由近红外光谱(NIRS)得到的局部脑血氧饱和度(RScO2)是一种可以接受的脑血流量替代指标，并已被验证用于CA的测量。这些数据表明了一种新的机制来构建基于近红外光谱测量的脑血氧仪的自动调节曲线。案例系列研究。三级医疗中心的神经危重监护室。急性神经损伤患者格拉斯哥昏迷评分≤8分。多模式连续监测rScO2和MAP后，在STATA中用分数多项式模型绘制自动调节曲线。7例患者的个性化自动调节曲线显示了不同的自动调节上下限，并提供了有关自动调节趋势的有用的临床信息(在急性昏迷期间曲线向右或向左移动)。自我调节下限和上限的中位数分别为86.5 mm Hg(IQR，74-93.5)和93.5 mm Hg(IQR，83-99)。这一病例系列研究表明，在至少24小时的记录后，无需外部刺激操纵MAP，就可以描绘CA平台的真实趋势并直接显示CA曲线。床边多模式监测与脑血氧仪的结合提供了一种新的、非侵入性的方法来描绘每日的个体CA曲线。
Critical care guidelines recommend a single target value for mean arterial blood pressure (MAP) in critically ill patients. However, growing evidence regarding cerebral autoregulation (CA) challenges this concept and supports individualizing MAP targets to prevent brain and kidney hypo- or hyperperfusion. Regional cerebral oxygen saturation (rScO2) derived from near-infrared spectroscopy (NIRS) is an acceptable surrogate for cerebral blood flow and has been validated to measure CA. These data suggest a novel mechanism to construct autoregulation curves based on NIRS-measured cerebral oximetry. Case-series study. Neurocritical care unit in a tertiary medical center. Patients with acute neurologic injury and Glasgow coma scale score ≤ 8. Autoregulation curves were plotted using the fractional-polynomial model in Stata after multimodal continuous monitoring of rScO2 and MAP. Individualized autoregulation curves of seven patients exhibited varying upper and lower limits of autoregulation and provided useful clinical information on the autoregulation trend (curves moving to the right or left during the acute coma period). The median lower and upper limits of autoregulation were 86.5 mmHg (IQR, 74-93.5) and 93.5 mmHg (IQR, 83-99), respectively. This case-series study showed feasibility of delineating real trends of the CA plateau and direct visualization of the CA curve after at least 24 hours of recording without manipulation of MAP by external stimuli. The integration of multimodal monitoring at the bedside with cerebral oximetry provides a novel, noninvasive method to delineate daily individual CA curves.