Citation

Friess SH. Crit. Care Med. 2023; 51(5): 680-682.

Copyright

(Copyright © 2023, Society of Critical Care Medicine, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/CCM.0000000000005813

PMID

37052438

Abstract

Severe traumatic brain injury (sTBI) in children continues to be a leading cause of death and disability worldwide. One of the primary goals of treatment for sTBI in the intensive care setting is the optimization of physiologic hemodynamic variables, such as intracranial pressure (ICP) and cerebral perfusion pressure (CPP), to prevent or minimize secondary brain injury. However, evidence for age-specific targets for CPP in children is weak (1), and the ideal CPP for individual patients, each in their own unique clinical environment, is determined nearly entirely at the discretion of bedside providers. Compounding this uncertainty are the physiologic derangements that result in dysfunctional cerebral autoregulation after sTBI, which impacts cerebrovascular hemodynamics and may result in patient-specific optimal CPPs that differ from recommended thresholds. More recently, assessments of autoregulation using bedside titration of vasopressors to augment mean arterial pressure (MAP) have begun to be incorporated into adult sTBI treatment algorithms in order to improve bedside CPP targeting (2). The pressure reactivity index (PRx) is a commonly used measurement of cerebrovascular reactivity, calculated as a moving correlation coefficient between ICP and MAP. The PRx ranges from -1 to 1, where values above 0 indicate altered or dysfunctional cerebral autoregulation (3). PRx is widely now used in adult clinical studies as a marker of cerebral autoregulation, but only a few small pediatric cohorts are described in the literature (4-6). With age-dependent differences in blood pressure, cerebral blood flow, and cerebrovascular response, larger pediatric study populations are needed before PRx-based assessments of cerebral autoregulation can be used to guide sTBI management in children...

Language: en