成人急性创伤性神经损伤中 RAP 补偿储备指数与连续多模态监测脑生理学、神经影像学和患者预后的关系:范围综述》。

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2024-09-13 eCollection Date: 2024-01-01 DOI:10.1089/neur.2024.0058
Abrar Islam, Izabella Marquez, Logan Froese, Nuray Vakitbilir, Alwyn Gomez, Kevin Y Stein, Tobias Bergmann, Amanjyot Singh Sainbhi, Frederick A Zeiler
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引用次数: 0

摘要

急性创伤性神经损伤,即创伤性脑损伤(TBI),是导致全球死亡和残疾的重要因素。理想情况下,持续监测脑顺应性/脑代偿储备可及时干预创伤性脑损伤病例,避免病情进一步严重恶化。RAP 被定义为颅内压(ICP)脉搏振幅波形与 ICP 之间的移动皮尔逊相关性,在这种情况下,RAP 被提议作为一种持续更新的指标。然而,相关文献仍很分散,难以浏览。因此,本次范围界定综述的目的是全面描述有关 RAP 及其与(1)其他多模态脑生理监测、(2)神经影像学特征和(3)患者长期预后相关性的文献。随后,我们对人类文献进行了系统性的范围界定审查,以突出 RAP 与连续多模态脑生理学监测、神经影像学和成年 TBI 患者预后之间的关联。我们的综述涵盖了 21 项关于这些主题的研究。主要研究结果包括对研究的细致分析,将研究结果分为三种 RAP 状态,以清楚地了解其与脑生理学和临床结果的关系。状态 1 表示健康状况,数值为接近零的小正值(RAP 0.4)。状态 3 出现在病情恶化的情况下,表现为代偿储备进一步受损、脑血管反应能力衰竭以及大脑自动调节功能紊乱。大量出现致命结果的患者均处于状态 3,其特点是 RAP 显著下降,在某些情况下甚至出现负值。本综述的意义在于为未来的研究方向建立了一个平台,以提高 RAP 在创伤性脑损伤护理中的精确性和临床意义,最终目的是防止从状态 2 过渡到状态 3,减轻致命后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of RAP Compensatory Reserve Index with Continuous Multimodal Monitoring Cerebral Physiology, Neuroimaging, and Patient Outcome in Adult Acute Traumatic Neural Injury: A Scoping Review.

Acute traumatic neural injury, known as traumatic brain injury (TBI), stands as a significant contributor to global mortality and disability. Ideally, continuously monitoring cerebral compliance/cerebral compensatory reserve would enable timely interventions and avert further substantial deterioration in TBI cases. RAP, defined as the moving Pearson's correlation between intracranial pressure (ICP) pulse amplitude waveform and ICP, has been proposed as a continuously updating index in this context. However, the literature remains scattered and difficult to navigate. Thus, the goal of this scoping review was to comprehensively characterize the literature regarding RAP and its association with (1) other multimodal cerebral physiological monitoring, (2) neuroimaging features, and (3) long-term patient outcomes. We subsequently conducted a systematic scoping review of the human literature to highlight the association of RAP with continuous multimodal monitoring of cerebral physiology, neuroimaging, and patient outcomes in the context of adult TBI patients. Our review encompassed 21 studies focusing on these topics. The primary findings involve meticulous analysis of studies, categorizing findings into three states of RAP to clearly understand its relation to cerebral physiology and clinical outcomes. State 1 signifies a healthy condition with a small positive value near zero (RAP <0.5). Conversely, state 2, a predominant characterization of TBI patients, indicates compromised compensatory reserve, featuring a large positive RAP value (RAP > 0.4). State 3 emerges in worsened conditions, showcasing further compromised compensatory reserve, exhausted cerebrovascular reactivity, and disturbed cerebral autoregulation. A substantial number of patients with fatal outcomes was found in state 3, marked by a notable occurrence of decreasing and, in some instances, negative RAP. The significance of this review lies in establishing a platform for future research directions to enhance the precision and clinical implications of RAP in TBI care, ultimately aiming to prevent the transition from state 2 to state 3 and mitigate fatal outcomes.

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CiteScore
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