Treatment targets based on autoregulation parameters in neurocritical care patients

Purpose of review This review summarizes the physiological basis of autoregulation-oriented therapy in critically ill patients, with a particular emphasis on individual targets based on parameters that describe autoregulation of cerebral blood flow. Recent findings The concepts of optimal cerebral perfusion (CPPopt) and arterial pressures (ABPopt), which both take advantage of continuous measures of cerebral autoregulation, recently have been introduced into clinical practice. It is hypothesized that if both pressures are used as individual targets and followed, the incidence and severity of dysautoregulation will diminish sufficiently to improve outcomes across the spectrum of acute neurological illnesses. These parameters have not been tested in randomized trials. However, a Phase II trial for CPPopt in Traumatic Brain Injury (COGITATE) is underway. Clinical series suggest that delirium following cardiac surgery may be reduced if blood pressure is actively regulated above the lower limit of autoregulation. In traumatic brain injury, using CPPopt as a single target allows monitoring of the upper and lower limits of autoregulation that provide a well tolerated ‘corridor’ for treatment. Pilot studies in which ABPopt is monitored in preterm newborns suggest fewer haemorrhagic events if blood pressure is closer to its optimal target. Brain imaging studies suggest worse tissue outcomes when blood pressure is below ABPopt. Summary Targeted control of brain and ...
Source: Current Opinion in Critical Care - Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research

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ConclusionPolyphenols protected against hyperglycemia ‐mediated alterations in cerebral endothelial cells and a mouse stroke model. It will be relevant to assess polyphenol‐based strategies to improve cerebrovascular damage and stroke recovery during diabetes.This article is protected by copyright. All rights reserved
Source: Molecular Nutrition and Food Research - Category: Food Science Authors: Tags: Research Article Source Type: research
We present a retrospective study of 33 patients positive for COVID-19 with neuroimaging-documented ICH and examine anticoagulation use in this population.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Hemorrhagic stroke in COVID-19 Source Type: research
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Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research
Publication date: Available online 20 May 2020Source: Neurología (English Edition)Author(s): P.B. García Jurado, E. Roldán Romero, M.E. Pérez Montilla, R. Valverde Moyano, I.M. Bravo Rey, F. Delgado Acosta, F.A. Bravo-Rodríguez
Source: Neurologia - Category: Neurology Source Type: research
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Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
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Source: Medgadget - Category: Medical Devices Authors: Tags: Exclusive Radiology Telemedicine Source Type: blogs
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Source: Neurocritical Care - Category: Neurology Source Type: research
To the best of our knowledge, this is the first study to evaluate the effects of asymmetrical cortical vessel sign (ACVS) on predicting clinical outcomes in patients with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT) therapy. ACVS might be a helpful neuroimaging predictor for 90 ‐day poor outcome in AIS patients treated with IVT. This finding may help physicians to identify patients at relatively high risk of poor prognosis. AbstractIntroductionTo assess whether the asymmetrical cortical vessel sign (ACVS) on susceptibility ‐weighted imaging (SWI) could predict 90‐day poor outcomes in anterior circ...
Source: Brain and Behavior - Category: Neurology Authors: Tags: ORIGINAL RESEARCH Source Type: research
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Source: Journal of Neurology - Category: Neurology Source Type: research
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Source: Journal of Neurology - Category: Neurology Source Type: research
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