Point of care ultrasound evaluation of cardio-cerebral coupling.

Ignacio J Previgliano, Hatem Soliman Aboumarie, Francisco M Tamagnone, Pablo M Merlo, Fernando A Sosa, Jose Feijoo, Maria C Carruega
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Abstract

Cardio-cerebral coupling (CCC) refers to the dynamic interplay between cardiac function and cerebral blood flow, essential for maintaining hemodynamic stability. Disruptions in CCC are particularly relevant in critical care, where they can exacerbate primary and secondary brain injuries. Ultrasound-based techniques, including transcranial Doppler, transcranial color-coded Doppler, and echocardiography, provide non-invasive methods to assess this relationship at the bedside. This scoping review explores the pathophysiology of CCC, ultrasound methodologies for its evaluation, and its clinical relevance. Key mechanisms such as cerebral autoregulation and neurovascular coupling are discussed, along with ultrasound-derived parameters like pulsatility index, resistance index, and cerebral perfusion pressure. While ultrasound is a valuable tool, its limitations include operator dependency and equipment variability. Emerging evidence suggests that ultrasound-guided protocols, including ultrasound-guided cardio-cerebral resuscitation protocol and ultrasound-guided brain injury treatment protocol, may improve resuscitation strategies and neurocritical care monitoring. Despite its potential, further research is necessary to standardize assessment methods and integrate ultrasound-based CCC evaluation into routine clinical practice. Ongoing multicenter studies are expected to provide robust evidence supporting its clinical utility in managing brain-injured patients.

心脑耦合的护理点超声评价。
心脑耦合(CCC)是指心功能和脑血流之间的动态相互作用,对维持血流动力学稳定至关重要。在重症监护中,CCC的中断尤其重要,因为它们会加重原发性和继发性脑损伤。基于超声的技术,包括经颅多普勒、经颅彩色编码多普勒和超声心动图,提供了在床边评估这种关系的非侵入性方法。本综述探讨了CCC的病理生理学、超声评估方法及其临床意义。讨论了脑自动调节和神经血管耦合等关键机制,以及脉搏指数、阻力指数和脑灌注压等超声衍生参数。虽然超声是一种有价值的工具,但它的局限性包括对操作人员的依赖性和设备的可变性。越来越多的证据表明,超声引导方案,包括超声引导心脑复苏方案和超声引导脑损伤治疗方案,可以改善复苏策略和神经危重症监护监测。尽管其潜力巨大,但需要进一步的研究来规范评估方法,并将基于超声的CCC评估纳入常规临床实践。正在进行的多中心研究有望提供强有力的证据,支持其在脑损伤患者管理中的临床应用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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