Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review
Cerebrovascular pressure reactivity plays a key role in maintaining constant cerebral blood flow. Unfortunately, this mechanism is often impaired in acute traumatic neural injury states, exposing the already injured brain to further pressure-passive insults. While there has been much work on the ass...
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| Language: | English |
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Mary Ann Liebert
2024-11-01
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| Series: | Neurotrauma Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/neur.2023.0115 |
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| author | Kevin Y. Stein Fiorella Amenta Logan Froese Alwyn Gomez Amanjyot Singh Sainbhi Nuray Vakitbilir Younis Ibrahim Abrar Islam Tobias Bergmann Izabella Marquez Frederick A. Zeiler |
| author_facet | Kevin Y. Stein Fiorella Amenta Logan Froese Alwyn Gomez Amanjyot Singh Sainbhi Nuray Vakitbilir Younis Ibrahim Abrar Islam Tobias Bergmann Izabella Marquez Frederick A. Zeiler |
| author_sort | Kevin Y. Stein |
| collection | DOAJ |
| description | Cerebrovascular pressure reactivity plays a key role in maintaining constant cerebral blood flow. Unfortunately, this mechanism is often impaired in acute traumatic neural injury states, exposing the already injured brain to further pressure-passive insults. While there has been much work on the association between impaired cerebrovascular reactivity following moderate/severe traumatic brain injury (TBI) and worse long-term outcomes, there is yet to be a comprehensive review on the association between cerebrovascular pressure reactivity and intracranial pressure (ICP) extremes. Therefore, we conducted a systematic review of the literature for all studies presenting a quantifiable statistical association between a continuous measure of cerebrovascular pressure reactivity and ICP in a human TBI cohort. The methodology described in the Cochrane Handbook for Systematic Reviews was used. BIOSIS, Cochrane Library, EMBASE, Global Health, MEDLINE, and SCOPUS were all searched from their inceptions to March of 2023 for relevant articles. Full-length original works with a sample size of ≥10 patients with moderate/severe TBI were included in this review. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 16 articles were included in this review. Studies varied in population characteristics and statistical tests used. Five studies looked at transcranial Doppler-based indices and 13 looked at ICP-based indices. All but two studies were able to present a statistically significant association between cerebrovascular pressure reactivity and ICP. Based on the findings of this review, impaired reactivity seems to be associated with elevated ICP and reduced ICP waveform complexity. This relationship may allow for the calculation of patient-specific ICP thresholds, past which cerebrovascular reactivity becomes persistently deranged. However, further work is required to better understand this relationship and improve algorithmic derivation of such individualized ICP thresholds. |
| format | Article |
| id | doaj-art-bc5c2989700e4e18baa717f848884a59 |
| institution | OA Journals |
| issn | 2689-288X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Mary Ann Liebert |
| record_format | Article |
| series | Neurotrauma Reports |
| spelling | doaj-art-bc5c2989700e4e18baa717f848884a592025-08-20T02:31:48ZengMary Ann LiebertNeurotrauma Reports2689-288X2024-11-015148349610.1089/neur.2023.0115Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping ReviewKevin Y. Stein0Fiorella Amenta1Logan Froese2Alwyn Gomez3Amanjyot Singh Sainbhi4Nuray Vakitbilir5Younis Ibrahim6Abrar Islam7Tobias Bergmann8Izabella Marquez9Frederick A. Zeiler10Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Undergraduate Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Undergraduate Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Undergraduate Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Canada.Cerebrovascular pressure reactivity plays a key role in maintaining constant cerebral blood flow. Unfortunately, this mechanism is often impaired in acute traumatic neural injury states, exposing the already injured brain to further pressure-passive insults. While there has been much work on the association between impaired cerebrovascular reactivity following moderate/severe traumatic brain injury (TBI) and worse long-term outcomes, there is yet to be a comprehensive review on the association between cerebrovascular pressure reactivity and intracranial pressure (ICP) extremes. Therefore, we conducted a systematic review of the literature for all studies presenting a quantifiable statistical association between a continuous measure of cerebrovascular pressure reactivity and ICP in a human TBI cohort. The methodology described in the Cochrane Handbook for Systematic Reviews was used. BIOSIS, Cochrane Library, EMBASE, Global Health, MEDLINE, and SCOPUS were all searched from their inceptions to March of 2023 for relevant articles. Full-length original works with a sample size of ≥10 patients with moderate/severe TBI were included in this review. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 16 articles were included in this review. Studies varied in population characteristics and statistical tests used. Five studies looked at transcranial Doppler-based indices and 13 looked at ICP-based indices. All but two studies were able to present a statistically significant association between cerebrovascular pressure reactivity and ICP. Based on the findings of this review, impaired reactivity seems to be associated with elevated ICP and reduced ICP waveform complexity. This relationship may allow for the calculation of patient-specific ICP thresholds, past which cerebrovascular reactivity becomes persistently deranged. However, further work is required to better understand this relationship and improve algorithmic derivation of such individualized ICP thresholds.https://www.liebertpub.com/doi/10.1089/neur.2023.0115cerebrovascular reactivitycerebral autoregulationICPTBI |
| spellingShingle | Kevin Y. Stein Fiorella Amenta Logan Froese Alwyn Gomez Amanjyot Singh Sainbhi Nuray Vakitbilir Younis Ibrahim Abrar Islam Tobias Bergmann Izabella Marquez Frederick A. Zeiler Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review Neurotrauma Reports cerebrovascular reactivity cerebral autoregulation ICP TBI |
| title | Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review |
| title_full | Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review |
| title_fullStr | Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review |
| title_full_unstemmed | Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review |
| title_short | Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review |
| title_sort | associations between intracranial pressure extremes and continuous metrics of cerebrovascular pressure reactivity in acute traumatic neural injury a scoping review |
| topic | cerebrovascular reactivity cerebral autoregulation ICP TBI |
| url | https://www.liebertpub.com/doi/10.1089/neur.2023.0115 |
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