Cerebral Autoregulation-oriented Therapy at the Bedside: A Comprehensive Review
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Lucia Rivera-Lara1, Andres Zorrilla-Vaca, Romergryko G Geocadin
1From the Departments of Neurology (L.R.-L., R.G.G., W.Z., M.A.M.) and Anesthesiology and Critical Care Medicine (L.R.-L., A.Z.-V., R.G.G., R.J.H., W.Z., M.A.M.), Johns Hopkins School of Medicine, Baltimore, Maryland; and School of Medicine, Faculty of Health, Universidad del Valle, Cali, Colombia (A.Z.-V.).
Abstract:
This comprehensive review summarizes the evidence regarding use of cerebral autoregulation-directed therapy at the bedside and provides an evaluation of its impact on optimizing cerebral perfusion and associated functional outcomes. Multiple studies in adults and several in children have shown the feasibility of individualizing mean arterial blood pressure and cerebral perfusion pressure goals by using cerebral autoregulation monitoring to calculate optimal levels. Nine of these studies examined the association between cerebral perfusion pressure or mean arterial blood pressure being above or below their optimal levels and functional outcomes. Six of these nine studies (66%) showed that patients for whom median cerebral perfusion pressure or mean arterial blood pressure differed significantly from the optimum, defined by cerebral autoregulation monitoring, were more likely to have an unfavorable outcome. The evidence indicates that monitoring of continuous cerebral autoregulation at the bedside is feasible and has the potential to be used to direct blood pressure management in acutely ill patients.