Citation

Donnelly JE, Young AMH, Brady K. Childs Nerv. Syst. 2017; 33(10): 1735-1744.

Affiliation

Departments of Pediatrics, Anesthesia, Critical Care, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St., WT-17417B, Houston, TX, 77030, USA. kmbrady@bcm.edu.

Copyright

(Copyright © 2017, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00381-017-3523-x

PMID

29149389

Abstract

BACKGROUND: Children who survive acute traumatic brain injury are at risk of death from subsequent brain swelling and secondary injury. Strict physiologic management in the ICU after traumatic brain injury is believed to be key to survival, and cerebral perfusion pressure is a prominent aspect of post brain injury care. However, optimal cerebral perfusion pressure targets for children are not known. Autoregulation monitoring has been used to delineate individualized optimal perfusion pressures for patients with traumatic brain injury. The methods to do so are diverse, confusing, and not universally validated.

METHODS: In this manuscript, we discuss the history of autoregulation monitoring, outline and categorize the methods used to measure autoregulation, and review the available validation data for methods used to monitor autoregulation.

CONCLUSIONS: Impaired autoregulation after traumatic brain injury is associated with a poor prognosis. Observational data suggests that optimal neurologic outcome and survival are associated with optimal perfusion pressure defined by autoregulation monitoring. No randomized, controlled, interventional data is available to assess autoregulation monitoring after pediatric traumatic brain injury.

Language: en

Keywords

Autoregulation; Cerebral perfusion pressure; Traumatic brain injury