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Cerebrovascular Autoregulation Monitoring in the Management of Adult Severe Traumatic Brain Injury

Authors :
Raimund Helbok
FS Taccone
J. Dureanteau
Ari Ercole
Michael N. Diringer
V. De Sloovere
Alex B. Valadka
Geert Meyfroidt
Michael D. Smith
Pierre Bouzat
Thomas P. Bleck
Frederick A. Zeiler
Nino Stocchetti
C. Hawthorne
Bart Depreitere
C. Robba
Luzius A. Steiner
Samuel Klein
Marcel J. H. Aries
Giuseppe Citerio
Jan-Oliver Neumann
Gregory W.J. Hawryluk
P. David Adelson
Stefan Wolf
Randall M. Chesnut
Depreitere, B. [0000-0002-7458-0648]
Apollo - University of Cambridge Repository
Depreitere, B [0000-0002-7458-0648]
Intensive Care
RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience
MUMC+: MA Medische Staf IC (9)
Depreitere, B
Citerio, G
Smith, M
Adelson, P
Aries, M
Bleck, T
Bouzat, P
Chesnut, R
De Sloovere, V
Diringer, M
Dureanteau, J
Ercole, A
Hawryluk, G
Hawthorne, C
Helbok, R
Klein, S
Neumann, J
Robba, C
Steiner, L
Stocchetti, N
Taccone, F
Valadka, A
Wolf, S
Zeiler, F
Meyfroidt, G
Source :
Neurocritical Care, 34(3), 731-738. Humana Press, Inc.
Publication Year :
2021

Abstract

Background Several methods have been proposed to measure cerebrovascular autoregulation (CA) in traumatic brain injury (TBI), but the lack of a gold standard and the absence of prospective clinical data on risks, impact on care and outcomes of implementation of CA-guided management lead to uncertainty. Aim To formulate statements using a Delphi consensus approach employing a group of expert clinicians, that reflect current knowledge of CA, aspects that can be implemented in TBI management and CA research priorities. Methods A group of 25 international academic experts with clinical expertise in the management of adult severe TBI patients participated in this consensus process. Seventy-seven statements and multiple-choice questions were submitted to the group in two online surveys, followed by a face-to-face meeting and a third online survey. Participants received feedback on average scores and the rationale for resubmission or rephrasing of statements. Consensus on a statement was defined as agreement of more than 75% of participants. Results Consensus amongst participants was achieved on the importance of CA status in adult severe TBI pathophysiology, the dynamic non-binary nature of CA impairment, its association with outcome and the inadvisability of employing universal and absolute cerebral perfusion pressure targets. Consensus could not be reached on the accuracy, reliability and validation of any current CA assessment method. There was also no consensus on how to implement CA information in clinical management protocols, reflecting insufficient clinical evidence. Conclusion The Delphi process resulted in 25 consensus statements addressing the pathophysiology of impaired CA, and its impact on cerebral perfusion pressure targets and outcome. A research agenda was proposed emphasizing the need for better validated CA assessment methods as well as the focused investigation of the application of CA-guided management in clinical care using prospective safety, feasibility and efficacy studies.

Details

Language :
English
ISSN :
15416933
Volume :
34
Issue :
3
Database :
OpenAIRE
Journal :
Neurocritical Care
Accession number :
edsair.doi.dedup.....57475dbf4468a9c5dcd538b14a36923c