Editorial Material
Endocrinology & Metabolism
Sergio Brasil, Ronney B. Panerai, Edson Bor-Seng-Shu, Ricardo C. Nogueira
Summary: Cerebral perfusion pressure (CPP), which is commonly used in neurocritical care, is calculated as the difference between mean arterial blood pressure and mean intracranial pressure. This commentary discusses recent physiological advances and bedside practice issues, suggesting that considering CPP under this perspective may lead to inaccurate assumptions and potentially misleading decision making.
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
(2023)
Article
Obstetrics & Gynecology
Lina Bergman, Catherine Cluver, Niclas Carlberg, Michael Belfort, Mary C. Tolcher, Ronney B. Panerai, Teelkien van Veen
Summary: Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia, which may be important in the pathophysiological pathway and constitute a therapeutic target in the prevention of cerebral complications in preeclampsia.
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
(2021)
Article
Multidisciplinary Sciences
Martin Rozanek, Josef Skola, Lenka Horakova, Valeriia Trukhan
Summary: This study conducted a retrospective analysis of multimodal monitoring data to explore the effects of common short-duration artifacts on the pressure reactivity index (PRx). The findings suggest that the impact of individual artifacts on the PRx index varies, and not all artifacts may need to be removed.
SCIENTIFIC REPORTS
(2022)
Article
Cardiac & Cardiovascular Systems
Samuel P. Klein, Veerle De Sloovere, Geert Meyfroidt, Bart Depreitere
Summary: This study provides new insights into the quadriphasic physiology of cerebrovascular autoregulation (CA) and reveals substantial intersubject variability in the limits of CA.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2022)
Article
Cardiac & Cardiovascular Systems
Isabel J. Sible, Daniel A. Nation
Summary: Blood pressure variability (BPV) is associated with cerebral blood flow (CBF) decline, especially under standard blood pressure-lowering strategies. However, the relationship between BPV and CBF in samples with strictly controlled blood pressure remains understudied. This study found that higher BPV in the standard treatment group was associated with CBF decline in all regions, particularly in medial temporal regions. In the intensive treatment group, elevated BPV was related to CBF decline only in the hippocampus.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2023)
Article
Critical Care Medicine
Zachary S. Bailey, Lai Yee Leung, Xiaofang Yang, Katherine Cardiff, Janice Gilsdorf, Deborah Shear, Patrick M. Kochanek
Summary: This study suggests that prehospital whole blood resuscitation and lower mean arterial pressure resuscitation thresholds can reduce the prehospital fluid requirement while still maintaining critical cerebral physiology in a model of hemorrhagic shock and concomitant traumatic brain injury.
Article
Clinical Neurology
Jatinder S. Minhas, Tom J. Moullaali, Gabriel J. E. Rinkel, Craig S. Anderson
Summary: Blood pressure is an important factor in managing intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage. However, there are controversies surrounding the management of blood pressure for these conditions. Current research involves analyzing patient data to determine the strength and direction of blood pressure changes and provide recommendations for clinical practice and future research.
Review
Critical Care Medicine
Cheng-Chieh Huang, Kuan-Chih Chen, Zih-Yang Lin, Yu-Hsuan Chou, Wen-Liang Chen, Tsung-Han Lee, Kun-Te Lin, Pei-You Hsieh, Cheng Hsu Chen, Chu-Chung Chou, Yan-Ren Lin
Summary: Experimental studies have shown that head-up positioning during CPR can significantly improve cerebral perfusion pressure and coronary perfusion pressure, while decreasing intracranial pressure. However, there were no significant differences in mean arterial pressure and frequency of return of spontaneous circulation between head-up CPR and supine CPR.
Article
Critical Care Medicine
Jennifer C. Laws, E. Haley Vance, Kristina A. Betters, Jessica J. Anderson, Sydney Fleishman, Christopher M. Bonfield, John C. Wellons III, Meng Xu, James C. Slaughter, Dario A. Giuse, Neal Patel, Lori C. Jordan, Michael S. Wolf
Summary: This retrospective observational study assessed the acute effects of ketamine on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children with severe traumatic brain injury (TBI). The results showed that ketamine reduced ICP during ICP crises, but had no significant effect when used for sedation. These findings suggest that ketamine may be considered as a treatment for intracranial hypertension in children with severe TBI.
CRITICAL CARE MEDICINE
(2023)
Article
Biology
Agata Gradys, Jakub Szrama, Zsolt Molnar, Przemyslaw Guzik, Krzysztof Kusza
Summary: This study evaluated the effects of protocolised cerebral perfusion pressure (CPP)-guided treatment on morbidity and functional outcome in patients with subarachnoid haemorrhage (SAH). The results showed a significant reduction in the incidence of delayed cerebral ischaemia and improved functional outcomes in the CPP-guided group. Therefore, CPP-guided treatment may be beneficial in preventing and treating haemodynamic instability and increased intracranial pressure in SAH patients.
Article
Critical Care Medicine
Maximiliano A. Hawkes, Mania Hajeb, Alejandro A. Rabinstein
Summary: Patients with PRES may have cerebral hypoperfusion despite severe hypertension. A perfusion study in the acute setting may be helpful to better understand the perfusion status and guide blood pressure treatment.
NEUROCRITICAL CARE
(2023)
Article
Critical Care Medicine
Teodor Svedung Wettervik, Anders Hanell, Timothy Howells, Anders Lewen, Per Enblad
Summary: The aim of this study was to investigate the association between absolute pressure reactivity index (PRx) values and cerebral perfusion pressure (CPP) with outcome in traumatic brain injury (TBI). The study found that a higher percentage of monitoring time with deviation from optimal CPP (CPPopt) and within the reactivity-thresholds of PRx were independently associated with favorable outcome.
JOURNAL OF NEUROTRAUMA
(2023)
Editorial Material
Clinical Neurology
Vladimir Hachinski, Leif Ostergaard
Summary: The article introduces a new evolutionary interpretation of the brain's circulation, emphasizing the importance of balancing low-pressure and high-pressure systems for optimal brain health.
Article
Critical Care Medicine
Jeanette Tas, Erta Beqiri, Ruud C. van Kaam, Marek Czosnyka, Joseph Donnelly, Roel H. Haeren, Iwan C. C. van der Horst, Peter J. Hutchinson, Sander M. J. van Kuijk, Analisa L. Liberti, David K. Menon, Cornelia W. E. Hoedemaekers, Bart Depreitere, Peter Smielewski, Geert Meyfroidt, Ari Ercole, Marcel J. H. Aries
Summary: This study evaluated the feasibility and safety of CA-guided CPP management in TBI patients requiring intracranial pressure monitoring and therapy. The results demonstrate that targeting an individual and dynamic CA-guided CPP is feasible and safe in TBI patients, encouraging further prospective trials powered for clinical outcomes.
JOURNAL OF NEUROTRAUMA
(2021)
Article
Physiology
Sergei Valkov, Jan Harald Nilsen, Rizwan Mohyuddin, Torstein Schanche, Timofei Kondratiev, Gary C. Sieck, Torkjel Tveita
Summary: The efficacy of cerebral autoregulation during hypothermic CPR is largely unknown and is aim of the present experiment. The results showed that continuous CPR for 3 h at 27 degrees C provided sufficient cerebral oxygen delivery to maintain aerobic metabolism and preserve cerebral autoregulation during the first 2-h period of CPR.
FRONTIERS IN PHYSIOLOGY
(2022)