Document Detail

Quantifying cerebral autoregulation in health and disease.
MedLine Citation:
PMID:  16563106     Owner:  NLM     Status:  PubMed-not-MEDLINE    
OBJECTIVE: To review methods of quantifying human cerebral autoregulation in health and disease. DATA SOURCES: Articles and published abstracts on methods to quantify cerebral autoregulation in health and disease. SUMMARY OF REVIEW: Cerebral autoregulation is defined as the relationship between cerebral blood flow and cerebral perfusion pressure. Complex neurohumoral processes are involved in myogenic and metabolic mechanisms to maintain cerebral blood flow at a constant level in the presence of fluctuating systemic and cerebral perfusion pressures. Despite advances in physiological measurement, there is no standard measurement of cerebral blood flow and quantifying cerebral autoregulation remains problematic. Clinical monitors such as transcranial Doppler and jugular bulb oximetry have high levels of error with poor specificity and sensitivity. Cerebral autoregulation is impaired in traumatic brain injury and subarachnoid haemorrhage, so that cerebral blood flow becomes pressure-passive. Hypotension is associated with significant secondary neuronal damage following traumatic brain injury. Hypertensive emergencies represent failure of the upper autoregulatory threshold, often with devastating neurological consequences. The monitoring and treatment of autoregulatory failure remains limited and is essentially directed at maintaining an appropriate systemic blood pressure. Consequently, the use of strategies to manipulate cerebral perfusion requires care and circumspection. CONCLUSIONS: Cerebral autoregulation is impaired with brain injury with cerebral blood flow often becoming pressure-passive. The monitoring and treatment of autoregulatory failure is limited and usually directed at maintaining systemic blood pressure with the effectiveness of this strategy often being unknown.
J A Myburgh
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine     Volume:  6     ISSN:  1441-2772     ISO Abbreviation:  Crit Care Resusc     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2006-03-27     Completed Date:  2006-05-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100888170     Medline TA:  Crit Care Resusc     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  59-67     Citation Subset:  -    
Department of Intensive Care Medicine, The St George Hospital, Sydney, NSW, Australia.
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