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Cerebral perfusion pressure

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https://www.readbyqxmd.com/read/29778299/cerebral-perfusion-pressure-threshold-to-prevent-delayed-cerebral-ischemia-after-aneurysmal-subarachnoid-hemorrhage
#1
Jiawei Cai, Wenhua Fang, Fuxiang Chen, Zhangya Lin, Yuanxiang Lin, Lianghong Yu, Peisen Yao, Dezhi Kang
OBJECTIVE: To seek a cerebral perfusion pressure (CPP) threshold that can reduce the occurrence of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We analyzed the clinical data of patients with the diagnosis of aSAH and underwent CPP monitoring in our department from February 2014 to December 2015. CPP was divided into four specified thresholds by every 10 mmHg increments, which were from 50 mmHg to 80 mmHg. The totally time ratio of CPP below each threshold was calculated...
May 16, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29770889/autoregulation-in-the-neuro-icu
#2
REVIEW
Anson Wang, Santiago Ortega-Gutierrez, Nils H Petersen
PURPOSE OF REVIEW: The purpose of this review is to briefly describe the concept of cerebral autoregulation, to detail several bedside techniques for measuring and assessing autoregulation, and to outline the impact of impaired autoregulation on clinical and functional outcomes in acute brain injury. Furthermore, we will review several autoregulation studies in select forms of acute brain injuries, discuss the potential for its use in patient management in the ICU, and suggest further avenues for research...
May 17, 2018: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/29750694/impact-of-2-distinct-levels-of-mean-arterial-pressure-on-near-infrared-spectroscopy-during-cardiac-surgery-secondary-outcome-from-a-randomized-clinical-trial
#3
Frederik Holmgaard, Anne G Vedel, Theis Lange, Jens C Nilsson, Hanne B Ravn
BACKGROUND: Near-infrared spectroscopy (NIRS) is used worldwide to monitor regional cerebral oxygenation (rScO2) during cardiopulmonary bypass (CPB). Intervention protocols meant to mitigate cerebral desaturation advocate to increase mean arterial pressure (MAP) when cerebral desaturation occurs. However, the isolated effect of MAP on rScO2 is uncertain. The aim of the present study was in a randomized, blinded design to elucidate the effect of 2 distinct levels of MAP on rScO2 values during CPB...
May 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29748200/extent-of-microstructural-tissue-damage-correlates-with-hemodynamic-failure-in-high-grade-carotid-occlusive-disease-an-mri-study-using-quantitative-t2-and-dsc-perfusion
#4
A Seiler, R Deichmann, U Nöth, A Lauer, W Pfeilschifter, O C Singer, M Wagner
BACKGROUND AND PURPOSE: Chronic hemodynamic impairment in high-grade carotid occlusive disease is thought to cause microstructural abnormalities that might be subclinical or lead to subtle symptoms including cognitive impairment. Quantitative MR imaging allows assessing pathologic structural changes beyond macroscopically visible tissue damage. In this study, high-resolution quantitative T2 mapping combined with DSC-based PWI was used to investigate quantitative T2 changes as a potential marker of microstructural damage in relation to hemodynamic impairment in patients with unilateral high-grade carotid occlusive disease...
May 10, 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29746600/impact-of-positive-end-expiratory-pressure-on-cerebral-hemodynamic-in-paediatric-patients-with-post-traumatic-brain-swelling-treated-by-surgical-decompression
#5
Silvia De Rosa, Gianluca Villa, Paola Franchi, Aldo Mancino, Federica Tosi, Marina Alessandra Martin, Simona Bazzano, Giorgio Conti, Silvia Maria Pulitanò
INTRODUCTION: The objective of our present study is to evaluate the impact of different PEEP levels on cerebral hemodynamic, gas exchanges and respiratory system mechanics in paediatric patients with post-traumatic brain swelling treated with decompressive craniectomy (DC). MATERIALS AND METHODS: A prospective physiologic study was carried out on 14 paediatric patients presenting with severe traumatic brain swelling treated with DC. Transcranial Doppler ultrasonography was performed on the middle cerebral artery bilaterally after DC...
2018: PloS One
https://www.readbyqxmd.com/read/29737226/blood-pressure-reduction-in-hypertensive-acute-ischemic-stroke-patients-does-not-affect-cerebral-blood-flow
#6
Mahesh Kate, Negar Asdaghi, Laura C Gioia, Brian Buck, Sumit R Majumdar, Thomas Jeerakathil, Ashfaq Shuaib, Derek Emery, Christian Beaulieu, Kenneth Butcher
The effect of blood pressure (BP) reduction on cerebral blood flow (CBF) in acute ischemic stroke is unknown. We measured regional CBF with perfusion-weighted MRI before and after BP treatment in a three-armed non-randomized prospective controlled trial. Treatment arm assignment was based on acute mean arterial pressure (MAP). Patients with (MAP) >120 mmHg ( n = 14) were treated with intravenous labetalol and sublingual (SL) nitroglycerin (labetalol group). Those with MAP 100-120 mmHg ( n = 17) were treated with SL nitroglycerin (0...
January 1, 2018: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/29734653/the-janus-face-of-vegf-in-stroke
#7
REVIEW
Samuel J Geiseler, Cecilie Morland
The family of vascular endothelial growth factors (VEGFs) are known for their regulation of vascularization. In the brain, VEGFs are important regulators of angiogenesis, neuroprotection and neurogenesis. Dysregulation of VEGFs is involved in a large number of neurodegenerative diseases and acute neurological insults, including stroke. Stroke is the main cause of acquired disabilities, and normally results from an occlusion of a cerebral artery or a hemorrhage, both leading to focal ischemia. Neurons in the ischemic core rapidly undergo necrosis...
May 4, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29732476/critical-thresholds-for-intracranial-pressure-vary-over-time-in-non-craniectomised-traumatic-brain-injury-patients
#8
Basil Nourallah, Frederick A Zeiler, Leanne Calviello, Peter Smielewski, Marek Czosnyka, David K Menon
BACKGROUND: Intracranial pressure (ICP)- and cerebral perfusion pressure (CPP)-guided therapy is central to neurocritical care for traumatic brain injury (TBI) patients. We sought to identify time-dependent critical thresholds for mortality and unfavourable outcome for ICP and CPP in non-craniectomised TBI patients. METHODS: This is a retrospective cohort study of 355 patients with moderate-to-severe TBI who received ICP monitoring and were managed without decompressive craniectomy in a tertiary hospital neurocritical care unit...
May 7, 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29731820/multimodal-monitoring-combined-with-hypothermia-for-the-management-of-severe-traumatic-brain-injury-a-case-report
#9
Jun-Hui Chen, Yi-Nong Xu, Meng Ji, Pei-Pei Li, Li-Kun Yang, Yu-Hai Wang
Traumatic brain injury (TBI) is a prominent public health issue that has a significant negative impact on patients and their family members. It is the leading cause of mortality and disability among young (below 50 years old) individuals. Intracranial hypertension (ICH) remains the single most difficult therapeutic challenge for the management of severe TBI. Therapeutic hypothermia may reduce intracranial hypertension and improve patient outcomes; however, the use of hypothermia is controversial. It has been reported that therapeutic hypothermia elicits no therapeutic benefit for patients with TBI...
May 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29727706/effects-of-head-up-vs-supine-cpr-on-cerebral-oxygenation-and-cerebral-metabolism-a-prospective-randomized-porcine-study
#10
Gabriel Putzer, Patrick Braun, Judith Martini, Ines Niederstätter, Julia Abram, Andrea Katharina Lindner, Sabrina Neururer, Miriam Mulino, Bernhard Glodny, Raimund Helbok, Peter Mair
BACKGROUND: Recent studies have shown that during cardiopulmonary resuscitation (CPR) head-up position (HUP) as compared to standard supine position (SUP) decreases intracranial pressure (ICP) and increases cerebral perfusion pressure (CPP). The impact of this manoeuvre on brain oxygenation and metabolism is not clear. We therefore investigated HUP as compared to SUP during basic life support (BLS) CPR for their effect on brain oxygenation and metabolism. METHODS: Twenty pigs were anaesthetized and instrumented...
May 1, 2018: Resuscitation
https://www.readbyqxmd.com/read/29702188/consistent-head-up-cardiopulmonary-resuscitation-haemodynamics-are-observed-across-porcine-and-human-cadaver-translational-models
#11
Johanna Moore, Joe Holley, Nicolas Segal, Mike Lick, José Labarère, Ralph J Frascone, Kenneth Dodd, Aaron Robinson, Charles Lick, Lauren Klein, Andrew Ashton, Angela McArthur, Adamantios Tsangaris, Anna Makaretz, Mike Makaretz, Guillaume Debaty, Paul E Pepe, Keith Lurie
AIM: The objectives were: 1) replicate key elements of Head Up (HUP) cardiopulmonary resuscitation (CPR) physiology in a traditional swine model of ventricular fibrillation (VF), 2) compare HUP CPR physiology in pig cadavers (PC) to the VF model 3) develop a new human cadaver (HC) CPR model, and 4) assess HUP CPR in HC. METHODS: Nine female pigs were intubated, and anesthetized. Venous, arterial, and intracranial access were obtained. After 6 min of VF, CPR was performed for 2 min epochs as follows: Standard (S)-CPR supine (SUP), Active compression decompression (ACD) CPR + impedance threshold device (ITD-16) CPR SUP, then ACD + ITD HUP CPR...
April 24, 2018: Resuscitation
https://www.readbyqxmd.com/read/29701426/is-invasive-pressure-monitoring-more-reliable-than-non-invasive-in-patients-with-cardiovascular-pathology-a-case-report
#12
Andreia Fernandes, Luísa Coimbra, Inês Delgado, José Carvalho, Carla Bentes
INTRODUCTION: Patients undergoing carotid endarterectomy (CEA) require strict arterial blood pressure (BP) control to maintain adequate cerebral perfusion. Invasive blood pressure (IBP) is the gold standard, however artifacts may lead to erroneous readings. METHODS: We report a case of CEA using IBP monitoring. RESULTS: A 64-year-old man, American Society Anaesthesiology (ASA) physical status 3 (diffuse atheromathosis, dyslipidemia and non-medicated hypertension), was presented for an elective right CEA...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29690910/haemodynamic-outcomes-during-piston-based-mechanical-cpr-with-or-without-active-decompression-in-a-porcine-model-of-cardiac-arrest
#13
Mikkel T Steinberg, Jan-Aage Olsen, Morten Eriksen, Andres Neset, Per Andreas Norseng, Jo Kramer-Johansen, Bjarne Madsen Hardig, Lars Wik
BACKGROUND: Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest compression device is capable of ACD-CPR, we modified the LUCAS 2 (Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesising it would improve haemodynamic outcomes compared with standard LUCAS CPR on pigs with cardiac arrest. METHODS: The modified LUCAS delivering 5 cm compressions with or without 2 cm active decompression above anatomical chest level was studied in a randomized crossover design on 19 Norwegian domestic pigs...
April 24, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29689105/cerebral-desaturation-in-heart-failure-potential-prognostic-value-and-physiologic-basis
#14
Yu-Jen Chen, Jong-Shyan Wang, Chih-Chin Hsu, Pyng-Jing Lin, Feng-Chun Tsai, Ming-Shien Wen, Chi-Tai Kuo, Shu-Chun Huang
Cerebral tissue oxygen saturation (SctO2) reflects cerebral perfusion and tissue oxygen consumption, which decline in some patients with heart failure with reduced ejection fraction (HFrEF) or stroke, especially during exercise. Its physiologic basis and clinical significance remain unclear. We aimed to investigate the association of SctO2 with oxygen transport physiology and known prognostic factors during both rest and exercise in patients with HFrEF or stroke. Thirty-four HFrEF patients, 26 stroke patients, and 17 healthy controls performed an incremental cardiopulmonary exercise test using a bicycle ergometer...
2018: PloS One
https://www.readbyqxmd.com/read/29682496/inotropes-for-preterm-infants-50-years-on-are-we-any-wiser
#15
REVIEW
Aisling A Garvey, Elisabeth M W Kooi, Eugene M Dempsey
For almost half a century, inotropes have been administered to preterm infants with the ultimate goal of increasing their blood pressure. A number of trials, the majority of which focused on dopamine administration, have demonstrated increased blood pressure following inotrope administration in preterm infants and have led to continued use of inotropes in our neonatal units. We have also seen an increase in the number of potential agents available to the clinician. However, we now know that hypotension is a much broader concept than blood pressure alone, and our aim should instead be focused on improving end organ perfusion, specifically cerebral perfusion...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29668325/is-cushing-mechanism-a-dynamic-blood-pressure-stabilizing-system-insights-from-granger-causality-analysis-of-spontaneous-blood-pressure-and-cerebral-blood-flow
#16
Saqib Saleem, Paul D Teal, Connor A Howe, Michael M Tymko, Philip N Ainslie, Yu-Chieh Tzeng
Blood pressure regulation is widely recognised as being integral to the control of end-organ perfusion but it remains unclear whether end-organ perfusion also plays a role in driving changes in blood pressure (BP). A randomized and placebo controlled study design was followed to examine the feedback relationships between very-low-frequency fluctuations in BP and cerebral blood flow (CBF) in humans under placebo treatment and α1-adrenergic blockade. To determine the causal relations among haemodynamic variables, BP, middle cerebral artery blood velocity (MCAv), and end-tidal CO2 time-series were decimated, low-pass filtered (<0...
April 18, 2018: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
https://www.readbyqxmd.com/read/29665012/wavelet-pressure-reactivity-index-a-validation-study
#17
Xiuyun Liu, Marek Czosnyka, Joseph Donnelly, Danilo Cardim, Manuel Cabeleira, Peter J Hutchinson, Xiao Hu, Peter Smielewski, Ken Brady
KEY POINTS: The brain is vulnerable to damage from too little or too much blood flow. A physiological mechanism called cerebral autoregulation (CA) exists to maintain stable blood flow even if cerebral perfusion pressure (CPP) is changing. A robust method for assessing CA is not yet available. There are still some problems with the traditional measure, the pressure reactivity index (PRx). We introduced a new method, wavelet transform method (wPRx) to assess CA using data from two sets of controlled hypotension experiments in piglets: One set with artificially manipulated ABP oscillations; the other group were spontaneous ABP waves...
April 17, 2018: Journal of Physiology
https://www.readbyqxmd.com/read/29660944/cardiovascular-response-to-mental-stress-in-mild-cognitive-impairment-and-its-association-with-cerebral-perfusion
#18
Brandon C Henley, Mahsa Shokouhi, Anushree Y Mahajan, Omer T Inan, Ihab Hajjar
Mental stress has been linked to various chronic diseases including Alzheimer's disease, but the mechanisms underlying cognitive decline with mental stress are unknown. Reduced cardiovascular response to stress is associated with cardiovascular disease, and the latter is associated with cognitive impairment. We measured electrodermal activity, blood pressure, and cardiac hemodynamics in cognitively normal and mild cognitive impairment (MCI) adults (n = 76, mean age = 58 years, 46% MCI) during rest, a math test, and face-name recall tasks to derive the following cardiovascular indicators: mean arterial pressure, heart rate, stroke volume and cardiac output...
April 11, 2018: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/29650049/variation-in-general-supportive-and-preventive-intensive-care-management-of-traumatic-brain-injury-a-survey-in-66-neurotrauma-centers-participating-in-the-collaborative-european-neurotrauma-effectiveness-research-in-traumatic-brain-injury-center-tbi-study
#19
Jilske A Huijben, Victor Volovici, Maryse C Cnossen, Iain K Haitsma, Nino Stocchetti, Andrew I R Maas, David K Menon, Ari Ercole, Giuseppe Citerio, David Nelson, Suzanne Polinder, Ewout W Steyerberg, Hester F Lingsma, Mathieu van der Jagt
BACKGROUND: General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. METHODS: We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study...
April 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29649509/cybersickness-related-changes-in-brain-hemodynamics-a-pilot-study-comparing-transcranial-doppler-and-near-infrared-spectroscopy-assessments-during-a-virtual-ride-on-a-roller-coaster
#20
Alireza Mazloumi Gavgani, Rachel H X Wong, Peter R C Howe, Deborah M Hodgson, Frederick R Walker, Eugene Nalivaiko
Our aim was to assess cerebral blood flow changes during cybersickness. Transcranial Doppler (TCD) ultrasound and near infrared spectroscopy (NIRS) were used separately in two independent experiments. In both studies, a 15-min virtual roller coaster ride was used as a provocative visual stimulus. Subjective nausea ratings were obtained at 1 min intervals. The TCD study was performed in 14 healthy subjects (8 males and 6 females); in this study we also measured heart rate and arterial pressure. In a separate study a 52-channel NIRS device (Hitachi ETG-4000) was used to monitor activated brain regions by measuring oxy-hemoglobin (HbO2) concentration in 9 healthy subjects (4 male, 5 females)...
April 9, 2018: Physiology & Behavior
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