Pressure Autoregulation Measurement Techniques in Adult Traumatic Brain Injury, Part I: A Scoping Review of Intermittent/Semi-Intermittent Methods.
Journal of neurotrauma
Mary Ann Liebert Inc.
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Zeiler, F., Donnelly, J., Calviello, L., Menon, D., Smielewski, P., & Czosnyka, M. (2017). Pressure Autoregulation Measurement Techniques in Adult Traumatic Brain Injury, Part I: A Scoping Review of Intermittent/Semi-Intermittent Methods.. Journal of neurotrauma, 34 (23), 3207-3223. https://doi.org/10.1089/neu.2017.5085
To perform a systematic, scoping review of commonly described intermittent/semi-intermittent autoregulation measurement techniques in adult TBI. Nine separate systematic reviews were conducted for each intermittent technique: Computed tomographic perfusion (CTP)/Xenon-CT (Xe-CT), positron emission tomography (PET), magnetic resonance imaging (MRI), arterio-venous difference in oxygen (AVDO2) technique, thigh cuff deflation technique (TCDT), transient hyperemic response test (THRT), orthostatic hypotension test (OHT), mean flow index (Mx) and transfer function ARI (TF-ARI). MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to December 2016) and reference lists of relevant articles were searched. A two-tier filter of references was conducted. The total number of articles utilizing each of the 9 searched techniques for intermittent/semi-intermittent autoregulation techniques in adult TBI were: CTP/Xe-CT (10), PET (6), MRI (0), AVDO2 (10), autoregulation index (ARI) based TCDT (9), THRT (6), OHT (3), Mx (17) and TF-ARI (6). The premise behind all of the intermittent techniques is manipulation of systemic blood pressure/blood volume via either chemical (such as vasopressors) or mechanical (such as thigh cuffs or carotid compression) means. Exceptionally, Mx and TF-ARI are based on spontaneous fluctuations of CPP or MAP. The method for assessing the cerebral circulation during these manipulations varies, with both imaging based techniques and TCD utilized. Despite the limited literature for intermittent/semi-intermittent techniques in adult TBI (minus Mx), it is important to acknowledge the availability of such tests. They have provided fundamental insight into human autoregulatory capacity, leading to the development of continuous and more commonly applied techniques in the ICU. Numerous methods of intermittent/semi-intermittent pressure autoregulation assessment in adult TBI exist, including: CTP/Xe-CT, PET, AVDO2 technique, TCDT based ARI, THRT, OHT, Mx and TF-ARI. MRI based techniques in adult TBI are yet to be described, with the main focus of MRI techniques on metabolic based CVR and not pressure-based autoregulation.
Humans, Homeostasis, Cerebrovascular Circulation, Adult, Neurophysiological Monitoring, Brain Injuries, Traumatic
This work was made possible through salary support through the Cambridge Commonwealth Trust Scholarship, the Royal College of Surgeons of Canada – Harry S. Morton Travelling Fellowship in Surgery, the University of Manitoba Clinician Investigator Program, R. Samuel McLaughlin Research and Education Award, the Manitoba Medical Service Foundation, and the University of Manitoba Faculty of Medicine Dean’s Fellowship Fund. JD is supported by a Woolf Fisher Scholarship (NZ). These studies were also supported by National Institute for Healthcare Research (NIHR, UK) through the Acute Brain Injury and Repair theme of the Cambridge NIHR Biomedical Research Centre, an NIHR Senior Investigator Award to DKM. Authors were also supported by a European Union Framework Program 7 grant (CENTER-TBI; Grant Agreement No. 602150)
Department of Health (via National Institute for Health Research (NIHR)) (unknown)
External DOI: https://doi.org/10.1089/neu.2017.5085
This record's URL: https://www.repository.cam.ac.uk/handle/1810/266129