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Cerebral perfusion pressure

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https://www.readbyqxmd.com/read/29149389/autoregulation-in-paediatric-tbi-current-evidence-and-implications-for-treatment
#1
REVIEW
Joseph E Donnelly, Adam M H Young, Ken Brady
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...
October 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29141501/transient-hypertension-after-spinal-cord-injury-leads-to-cerebrovascular-endothelial-dysfunction-and-fibrosis
#2
Aaron A Phillips, Nusrat Matin, Mengyao Jia, Jordan W Squair, Aaron Monga, Mei Mu Zi Zheng, Rahul Sachdeva, Andrew Yung, Shea Hocolaski, Stacy L Elliott, Piotr Kozlowski, Anne Dorrance, Ismail Laher, Phil Ainslie, Andrei V Krassioukov
We aimed to create a clinically-relevant preclinical model of transient hypertension, and then evaluate the pathophysiological cerebrovascular processes resulting from this novel stimulus, which has recently been epidemiologically linked to cerebrovascular disease. We first developed a clinically-relevant model of transient hypertension, secondary to induced autonomic dysreflexia after spinal cord injury, and demonstrated that in both patients and rats this stimulus leads to drastic acute cerebral hyper-perfusion...
November 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29140888/intrathoracic-pressure-regulation-improves-cerebral-perfusion-and-cerebral-blood-flow-in-a-porcine-model-of-brain-injury-erratum
#3
(no author information available yet)
No abstract text is available yet for this article.
December 2017: Shock
https://www.readbyqxmd.com/read/29132572/secondary-gains-advances-in-neurotrauma-management
#4
REVIEW
Brit Long, Alex Koyfman
Neurotrauma is a leading cause of death and is associated with many secondary injuries. A balance of mean arterial pressure (MAP) and intracranial pressure (ICP) is required to ensure adequate cerebral blood flow and cerebral perfusion pressure. Evaluation and management in the emergency department entails initial stabilization and resuscitation while assessing neurologic status. ICP management follows a tiered approach. Intubation requires consideration of preoxygenation, head of bed elevation, first pass success, and adequate analgesia and sedation...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29129151/false-positive-diagnosis-of-brain-death-following-the-pediatric-guidelines-case-report-and-discussion
#5
D Alan Shewmon
A 2-year-old boy with severe head trauma was diagnosed brain dead according to the 2011 Pediatric Guidelines. Computed tomographic (CT) scan showed massive cerebral edema with herniation. Intracranial pressures were extremely high, with cerebral perfusion pressures around 0 for several hours. An apnea test was initially contraindicated; later, one had to be terminated due to oxygen desaturation when the Pco2 had risen to 57.9 mm Hg. An electroencephalogram (EEG) was probably isoelectric but formally interpreted as equivocal...
December 2017: Journal of Child Neurology
https://www.readbyqxmd.com/read/29123881/unexpected-complications-immediately-after-cranioplasty
#6
Akihito Kato, Hiroyuki Morishima, Goro Nagashima
Case: An 84-year-old man with subarachnoid hemorrhage underwent craniotomy and clipping with external decompression. Perfusion magnetic resonance imaging showed subclinical sinking skin flap syndrome, and he underwent cranioplasty on postoperative day 58. No problems occurred during the operation, but cerebral edema and hemorrhage were recognized on immediate postoperative computed tomography. Edema continued to progress, but edema and bleeding eventually improved without additional surgery...
July 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29122959/prefrontal-oxygenation-correlates-to-the-responses-in-facial-skin-blood-flows-during-exposure-to-pleasantly-charged-movie
#7
Kanji Matsukawa, Kana Endo, Ryota Asahara, Miho Yoshikawa, Shinya Kusunoki, Tomoko Ishida
Our laboratory reported that facial skin blood flow may serve as a sensitive tool to assess an emotional status. Cerebral neural correlates during emotional interventions should be sought in relation to the changes in facial skin blood flow. To test the hypothesis that prefrontal activity has positive relation to the changes in facial skin blood flow during emotionally charged stimulation, we examined the dynamic changes in prefrontal oxygenation (with near-infrared spectroscopy) and facial skin blood flows (with two-dimensional laser speckle and Doppler flowmetry) during emotionally charged audiovisual challenges for 2 min (by viewing comedy, landscape, and horror movie) in 14 subjects...
November 2017: Physiological Reports
https://www.readbyqxmd.com/read/29117033/challenges-of-cerebral-perfusion-pressure-measurement
#8
Sarah L Livesay, Molly M McNett, Monica Keller, DaiWai M Olson
Monitoring cerebral perfusion pressure (CPP) is recommended by a number of clinical practice guidelines and is a routine function performed by critical care neuroscience nurses. However, several studies highlight theoretical and practice variations in the measurement of CPP regarding the location of the arterial pressure transducer during measurement. Agreement on the technique and process for obtaining valid measurements is lacking. This article identifies the challenges associated with CPP measurement and highlights opportunities for standardizing CPP measurement to improve consistency in care and findings reported in the research literature...
December 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/29113858/differences-in-blood-pressure-by-measurement-technique-in-neurocritically-ill-patients-a-technological-assessment
#9
Abhijit V Lele, Daren Wilson, Prabhakar Chalise, Jules Nazzaro, Vijay Krishnamoorthy, Monica S Vavilala
Blood pressure data may vary by measurement technique. We performed a technological assessment of differences in blood pressure measurement between non-invasive blood pressure (NIBP) and invasive arterial blood pressure (ABP) in neurocritically ill patients. After IRB approval, a prospective observational study was performed to study differences in systolic blood pressure (SBP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) values measured by NIBP arm, ABP at level of the phlebostatic axis (ABP heart) and ABP at level of the external auditory meatus (ABP brain) at 30 and 45-degree head of bed elevation (HOB) using repeated measure analysis of covariance and correlation coefficients...
November 4, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29104807/neural-vascular-mechanism-for-the-cerebral-blood-flow-autoregulation-after-hemorrhagic-stroke
#10
REVIEW
Ming Xiao, Qiang Li, Hua Feng, Le Zhang, Yujie Chen
During the initial stages of hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, the reflex mechanisms are activated to protect cerebral perfusion, but secondary dysfunction of cerebral flow autoregulation will eventually reduce global cerebral blood flow and the delivery of metabolic substrates, leading to generalized cerebral ischemia, hypoxia, and ultimately, neuronal cell death. Cerebral blood flow is controlled by various regulatory mechanisms, including prevailing arterial pressure, intracranial pressure, arterial blood gases, neural activity, and metabolic demand...
2017: Neural Plasticity
https://www.readbyqxmd.com/read/29103945/central-sympathetic-nervous-system-reinforcement-in-obstructive-sleep-apnoea
#11
REVIEW
Magdalena Wszedybyl-Winklewska, Jacek Wolf, Arkadiusz Szarmach, Pawel J Winklewski, Edyta Szurowska, Krzysztof Narkiewicz
The available studies on cerebrovascular reactivity and cerebral oxygenation in obstructive sleep apnoea (OSA) patients brought conflicting results, yet the overall evidence suggests that resting state cerebral perfusion is diminished in these patients. Interestingly, in a group of healthy professional breath-hold divers who are exercising very long apnoeas - episodes corresponding to the ones observed in patients with OSA - demonstrated that cerebral oxygenation may remain stable at the expense of extreme sympathetic nervous system (SNS) activation...
September 9, 2017: Sleep Medicine Reviews
https://www.readbyqxmd.com/read/29094868/hemodynamics-during-dialysis-and-changes-in-cognitive-performance
#12
Dawn Wolfgram, Elisabeth Vogt, Allison L Jahn, Heather M Smith, Joleen Sussman, Alexis Visotcky, Purushottam Laud, Jeff Whittle
INTRODUCTION: Hemodialysis (HD) patients are at increased risk for cognitive impairment. Blood pressure (BP) fluctuations during HD may affect cerebral perfusion and subsequently cognitive function. OBJECTIVE: Examine and provide information on the relationship between intradialytic hemodynamics and cognitive outcomes over a 1-year period. METHODS: HD patients without diagnosed dementia who were 50 years old or older were given a neurocognitive battery at baseline and at 1-year follow-up...
December 2016: WMJ: Official Publication of the State Medical Society of Wisconsin
https://www.readbyqxmd.com/read/29089921/the-neurological-wake-up-test-a-role-in-neurocritical-care-monitoring-of-traumatic-brain-injury-patients
#13
REVIEW
Niklas Marklund
The most fundamental clinical monitoring tool in traumatic brain injury (TBI) patients is the repeated clinical examination. In the severe TBI patient treated by continuous sedation in a neurocritical care (NCC) unit, sedation interruption is required to enable a clinical evaluation (named the neurological wake-up test; NWT) assessing the level of consciousness, pupillary diameter and reactivity to light, and presence of focal neurological deficits. There is a basic conflict regarding the NWT in the NCC setting; can the clinical information obtained by the NWT justify the risk of inducing a stress response in a severe TBI patient? Furthermore, in the presence of advanced multimodal monitoring and neuroimaging, is the NWT necessary to identify important clinical alterations? In studies of severe TBI patients, the NWT was consistently shown to induce a stress reaction including brief increases in intracranial pressure (ICP) and changes in cerebral perfusion pressure (CPP)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29084196/multi-modality-neuromonitoring-in-severe-pediatric-traumatic-brain-injury-monitoring-pediatric-tbi
#14
REVIEW
Adam M H Young, Mathew R Guilfoyle, Joseph Donnelly, Peter Smielewski, Shruti Agarwal, Marek Czosnyka, Peter J Hutchinson
Each year, the annual hospitalization rates of traumatic brain injury (TBI) in children in the US are 57.7 per 100 K less than 5 years of age and 23.1 per 100 K in the 5-14 year age group. Despite this, little is known about the pathophysiology of TBI in children and how to manage it most effectively. Historically, TBI management has been guided by clinical examination. This has been assisted progressively by clinical imaging, intracranial pressure (ICP) monitoring and finally software that can calculate optimal brain physiology...
October 30, 2017: Pediatric Research
https://www.readbyqxmd.com/read/29078756/effects-of-lung-protective-mechanical-ventilation-associated-with-permissive-respiratory-acidosis-on-regional-extra-pulmonary-blood-flow-in-experimental-ards
#15
Rudolf Hering, Stefan Kreyer, Christian Putensen
BACKGROUND: Lung protective mechanical ventilation with limited peak inspiratory pressure has been shown to affect cardiac output in patients with ARDS. However, little is known about the impact of lung protective mechanical ventilation on regional perfusion, especially when associated with moderate permissive respiratory acidosis. We hypothesized that lung protective mechanical ventilation with limited peak inspiratory pressure and moderate respiratory acidosis results in an increased cardiac output but unequal distribution of blood flow to the different organs of pigs with oleic-acid induced ARDS...
October 27, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29076947/left-versus-biventricular-assist-devices-in-cardiac-arrest
#16
Erik J S Packer, Grete Slettom, Atle Solholm, Arve Mongstad, Rune Haaverstad, Vegard Tuseth, Ketil Grong, Jan Erik Nordrehaug
Maintaining adequate organ perfusion during cardiac arrest remains a challenge, and various assist techniques have been evaluated. We assessed whether a right ventricular impeller assist device (RVAD) in adjunct to a left ventricular impeller assist device (LVAD) is beneficial. Twenty anesthetized pigs were randomized to maximized circulatory support by percutaneously implanted left- or biventricular assist device(s) during 30 minutes of electrically induced ventricular fibrillation followed by three attempts of cardioversion...
October 20, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29074711/enhanced-cerebral-perfusion-during-brief-exposures-to-cyclic-intermittent-hypoxemia
#17
Xiaoli Liu, Diqun Xu, James R Hall, Sarah Ross, Shande Chen, Howe Liu, Robert T Mallet, Xiangrong Shi
Cerebral vasodilation and increased cerebral oxygen extraction help maintain cerebral oxygen uptake in the face of hypoxemia. This study examined cerebrovascular responses to intermittent hypoxemia in eight healthy men breathing 10% O2 for 5 cycles, each 6 min, interspersed with 4 min of room air breathing. Hypoxia exposures raised heart rate (P<0.01) without altering arterial pressure, and increased ventilation (P<0.01) by expanding tidal volume. Arterial oxygen saturation (SaO2) and cerebral tissue oxygenation (ScO2) fell (P<0...
October 26, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29067632/a-national-trial-on-differences-in-cerebral-perfusion-pressure-values-by-measurement-location
#18
Molly M McNett, Mary Kay Bader, Sarah Livesay, Susan Yeager, Cristina Moran, Arianna Barnes, Kimberly R Harrison, DaiWai M Olson
BACKGROUND: Cerebral perfusion pressure (CPP) is a key parameter in management of brain injury with suspected impaired cerebral autoregulation. CPP is calculated by subtracting intracranial pressure (ICP) from mean arterial pressure (MAP). Despite consensus on importance of CPP monitoring, substantial variations exist on anatomical reference points used to measure arterial MAP when calculating CPP. This study aimed to identify differences in CPP values based on measurement location when using phlebostatic axis (PA) or tragus (Tg) as anatomical reference points...
October 24, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29061152/individualized-perfusion-targets-in-hypoxic-ischemic-brain-injury-after-cardiac-arrest
#19
Mypinder S Sekhon, Donald E Griesdale
Secondary injury is a major determinant of outcome in hypoxic ischemic brain injury (HIBI) after cardiac arrest and may be mitigated by optimizing cerebral oxygen delivery (CDO2). CDO2 is determined by cerebral blood flow (CBF), which is dependent upon mean arterial pressure (MAP). In health, CBF remains constant over the MAP range through cerebral autoregulation. In HIBI, the zone of intact cerebral autoregulation is narrowed and varies for each patient. Maintaining MAP within the intact autoregulation zone may mitigate ischemia, hyperemia and secondary injury...
October 24, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29059301/steady-state-vs-pulsatile-blood-pressure-component-and-regional-cerebral-perfusion
#20
Jitanan Laosiripisan, Andreana P Haley, Hirofumi Tanaka
BACKGROUND: Arterial blood pressure (BP) can be divided into steady state component that is determined by mean arterial pressure and pulsatile component that is explored by pulse pressure (PP). We determined relationships between BP components and regional cerebral perfusion. METHODS: A total of 52 apparently healthy and cognitively normal adults aged 40-60 years were studied. Regional cerebral perfusion was measured using functional magnetic resonance imaging (MRI) arterial spin labeling technique in 10 a priori regions of interest...
November 1, 2017: American Journal of Hypertension
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