In recent years, physiologic insights into the cerebrovascular pathophysiology of
hypoxic-ischemic brain injury (HIBI) have been gleaned from studies examining invasive
neuromonitoring in patients post-cardiac arrest.
1
,
2
,
3
In the latest issue of Resuscitation, Balu and colleagues conducted a single center retrospective cohort study of invasive
neuromonitoring in HIBI patients which demonstrated associations between intracranial
hypertension as well as dysfunctional cerebral autoregulation, measured using pressure
reactivity index (PRx), and adverse clinical outcome.
4
We congratulate the authors on providing a valuable contribution to this rapidly
evolving field. Notwithstanding, there are key considerations which must be taken
into account when interpreting the utility of PRx as a measure of autoregulation in
the cerebrovascular pathophysiology of acute brain injuries, namely HIBI.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest.Crit Care Med. 2019; 47: 960-969
- Intracranial pressure and compliance in hypoxic ischemic brain injury patients after cardiac arrest.Resuscitation. 2019; 141: 96-103
- Brain hypoxia secondary to diffusion limitation in hypoxic ischemic brain injury post-cardiac arrest.Crit Care Med. 2020; 48: 378-384
- Cerebrovascular pressure reactivity and intracranial pressure are associated with neurologic outcome after hypoxic-ischemic brain injury.Resuscitatioin. 2021; 164: 114-121
- Integrative regulation of human brain blood flow.J Physiol. 2014; 592: 841-859
- Nitric oxide is fundamental to neurovascular coupling in humans.J Physiol. 2020; 598: 4927-4939
- Monitoring of cerebral autoregulation.Neurocrit Care. 2014; : 95-102
- Continuous assessment of the cerebral vasomotor reactivity in head injury.Neurosurgery. 1997; 41 (discussion 17–19): 11-17
- Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury.Crit Care Med. 2002; 30: 733-738
- Continuous monitoring of the Monro-Kellie doctrine: is it possible?.J Neurotrauma. 2012; 29: 1354-1363
- Cerebral blood flow and oxygen consumption in man.Physiol Rev. 1959; 39: 183-238
- Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury.Crit Care Med. 2012; 40: 2456-2463
- Continuous monitoring of cerebrovascular pressure reactivity in patients with head injury.Neurosurg Focus. 2008; 25: E2
- Monitoring and interpretation of intracranial pressure after head injury.Acta Neurochir Suppl. 2006; 96: 114-118
- Impaired autoregulation of cerebral blood flow during rewarming from hypothermic cardiopulmonary bypass and its potential association with stroke.Anesth Analg. 2010; 110: 321-328
- Cerebrovascular reactivity during hypothermia and rewarming.Br J Anaesth. 2007; 99: 237-244
- Neurologic injury associated with rewarming from hypothermia: is mild hypothermia on bypass better than deep hypothermic circulatory arrest?.Front Pediatr. 2016; 4: 104
- Rewarming from therapeutic hypothermia induces cortical neuron apoptosis in a swine model of neonatal hypoxic-ischemic encephalopathy.J Cereb Blood Flow Metab. 2015; 35: 781-793
- Cerebral autoregulation after hypothermic circulatory arrest in operations on the aortic arch.Ann Thorac Surg. 2004; 77: 72-79
- Hippocampus and basal ganglia as potential sentinel sites for ischemic pathology after resuscitated cardiac arrest.Resuscitation. 2019; 139: 230-233
- Regional differences in cerebral glucose metabolism after cardiac arrest and resuscitation in rats using [18F]FDG positron emission tomography and autoradiography.Neurocrit Care. 2018; 28: 370-378
- Magnetic resonance imaging assessment of regional cerebral blood flow after asphyxial cardiac arrest in immature rats.J Cereb Blood Flow Metab. 2009; 29: 197-205
- Global and regional differences in cerebral blood flow after asphyxial versus ventricular fibrillation cardiac arrest in rats using ASL-MRI.Resuscitation. 2014; 85: 964-971
- Enduring disturbances in regional cerebral blood flow and brain oxygenation at 24 h after asphyxial cardiac arrest in developing rats.Pediatr Res. 2017; 81: 94-98
- Positron emission tomography after ischemic brain injury: current challenges and future developments.Transl Stroke Res. 2020; 11: 628-642
- Intracranial pressure and compliance in hypoxic ischemic brain injury patients after cardiac arrest.Resuscitation. 2019; 141: 96-103
- Differential pathophysiologic phenotypes of hypoxic ischemic brain injury: considerations for post-cardiac arrest trials.Intensive Care Med. 2020; 46: 1969-1971
Article info
Publication history
Published online: May 14, 2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
