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Pressure reactivity index: journey through the past 20 years
Marek Czosnyka1, Zofia Czosnyka2, Peter Smielewski2
1Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Box 167, Addenbrookes Hospital, Cambridge, Cb20QQ, UK. mc141@medschl.cam.ac.uk.
Abstract:
Autoregulation after traumatic brain injury can be monitored continuously using simple signal processing of intracranial pressure and arterial blood pressure. The pressure reactivity index (PRx) showed several benefits when it was applied to continuous brain monitoring. Among them, a positive and strong correlation with the outcome and possibility of calculation of 'optimal cerebral perfusion pressure' have been listed. For this methodology, prospective clinical trials are missing-few of them are planned in the near future.
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A key factor in assessing the reactivity of the acid derivatives is the basicity of the substituent or the leaving group. The lower the basicity of the leaving group, the higher the reactivity of the derivative. The basicity of the leaving group follows this order:
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