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Published on: December 10, 2014
Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review
Yaroslava Longhitano1, Francesca Iannuzzi2, Giulia Bonatti3
1Department of Anesthesiology and Critical Care, AO St. Antonio, Biagio and Cesare Arrigo, Alessandria, Italy.
Insights
Impaired cerebral autoregulation (CA) in non-brain injured patients is linked to worse outcomes. Monitoring CA may help optimize treatment and improve patient management.
Area of Science:
- Neurology
- Critical Care Medicine
Background:
- Cerebral autoregulation (CA) is crucial for maintaining stable cerebral blood flow (CBF).
- Previous research primarily focused on CA in brain-injured patients.
- This study explores the significance of CA in non-brain injured individuals.
Approach:
- A systematic literature review was conducted.
- Searches included terms like "CA and sepsis," "CA and surgery," and "CA and non-brain injury."
- Twenty-two studies were analyzed, categorized into sepsis, surgical settings, and pediatric populations.
Key Points:
- Impaired CA in sepsis and during surgery correlates with increased incidence of sepsis-associated delirium.
- In pediatric cardiac surgery, the role and measurement of CA require further investigation.
- Studies indicate a link between impaired CA and adverse outcomes in non-brain injured patients.
Conclusions:
- Dysfunctional CA in non-brain injured patients can lead to cognitive deficits, neurological damage, and increased mortality.
- CA monitoring may offer a valuable tool for personalized clinical management in this patient group.
- Further research is needed to fully elucidate CA's role and measurement in specific non-brain injured populations.
Abstract:
Introduction: Cerebral autoregulation (CA) plays a fundamental role in the maintenance of adequate cerebral blood flow (CBF). CA monitoring, through direct and indirect techniques, may guide an appropriate therapeutic approach aimed at improving CBF and reducing neurological complications; so far, the role of CA has been investigated mainly in brain-injured patients. The aim of this study is to investigate the role of CA in non-brain injured patients. Methods: A systematic consultation of literature was carried out. Search terms included: "CA and sepsis," "CA and surgery," and "CA and non-brain injury." Results: Our research individualized 294 studies and after screening, 22 studies were analyzed in this study. Studies were divided in three groups: CA in sepsis and septic shock, CA during surgery, and CA in the pediatric population. Studies in sepsis and intraoperative setting highlighted a relationship between the incidence of sepsis-associated delirium and impaired CA. The most investigated setting in the pediatric population is cardiac surgery, but the role and measurement of CA need to be further elucidated. Conclusion: In non-brain injured patients, impaired CA may result in cognitive dysfunction, neurological damage, worst outcome, and increased mortality. Monitoring CA might be a useful tool for the bedside optimization and individualization of the clinical management in this group of patients.
