J Neurointensive Care.  2018 Oct;1(1):7-11. 10.32587/jnic.2018.00038.

New Parameters for Evaluating Cerebral Autoregulation and Pressure-Volume Compensatory Reserve in Neurocritial Patients

• Cho WS
• Ha EJ
• Ko SB
• Yang S
• Kim HC
• Kim JE

• KMID: 2555412
• DOI: http://doi.org/10.32587/jnic.2018.00038

Abstract

The goals of neurocritical care are to resolve primary causes, minimize secondary insults and maximize patient recovery. Concepts such as intracranial pressure (ICP), cerebral perfusion pressure (CPP) and cerebral blood flow have been long applied in neurocritical care; however, patient care involving these concepts alone is not satisfactory. Recently, new developments have allowed integrative physiological and biochemical data to be acquired and analyzed using multimodality monitoring with invasive devices. In addition, newly developed parameters have contributed to improvement in clinical outcomes in neurocritical patients. Beyond the indiscriminate application of threshold values for ICP and CPP in all patients, precision care can be provided by finding the optimal values of parameters and adjusting treatment for each patient in a particular time period. Here, we introduce representative parameters including the pressure reactivity index (PRx) for evaluating the status of cerebral autoregulation and optimal CPP (CPPopt) and the correlation between the amplitude of ICP and the mean ICP (RAP) for assessing the pressure-volume compensatory reserve. Additionally, we present a bedside software and monitoring system that we recently developed for analyzing these parameters.

Keyword

Neurocritical care; PRx; CPP; RAP