Abstract：
OBJECTIVE: Continuous cerebrovascular reactivity monitoring in both neurocritical and intra-operative care has gained extensive interest in recent years, as it has documented associations with long-term outcomes (in neurocritical care populations) and cognitive outcomes (in operative cohorts). This has sparked further interest into the exploration and evaluation of methods to achieve an optimal cerebrovascular reactivity measure, where the individual patient is exposed to the lowest insult burden of impaired cerebrovascular reactivity. Recent literature has documented, in neural injury populations, the presence of a potential optimal sedation level in neurocritical care, based on the relationship between cerebrovascular reactivity and quantitative depth of sedation (using bispectral index (BIS)) - termed BISopt. The presence of this measure outside of neural injury patients has yet to be proven.
METHODS: We explore the relationship between BIS and continuous cerebrovascular reactivity in two cohorts: (A) healthy population undergoing elective spinal surgery under general anesthesia, and (B) healthy volunteer cohort of awake controls.
RESULTS: We demonstrate the presence of BISopt in the general anesthesia population (96% of patients), and its absence in awake controls, providing preliminary validation of its existence outside of neural injury populations. Furthermore, we found BIS to be sufficiently separate from overall systemic blood pressure, this indicates that they impact different pathophysiological phenomena to mediate cerebrovascular reactivity.
CONCLUSIONS: Findings here carry implications for the adaptation of the individualized physiologic BISopt concept to non-neural injury populations, both within critical care and the operative theater. However, this work is currently exploratory, and future work is required.
METHODS: We explore the relationship between BIS and continuous cerebrovascular reactivity in two cohorts: (A) healthy population undergoing elective spinal surgery under general anesthesia, and (B) healthy volunteer cohort of awake controls.
RESULTS: We demonstrate the presence of BISopt in the general anesthesia population (96% of patients), and its absence in awake controls, providing preliminary validation of its existence outside of neural injury populations. Furthermore, we found BIS to be sufficiently separate from overall systemic blood pressure, this indicates that they impact different pathophysiological phenomena to mediate cerebrovascular reactivity.
CONCLUSIONS: Findings here carry implications for the adaptation of the individualized physiologic BISopt concept to non-neural injury populations, both within critical care and the operative theater. However, this work is currently exploratory, and future work is required.
摘要：
目的：近年来，在神经危重症和术中护理中进行连续的脑血管反应性监测获得了广泛的兴趣，因为它记录了与长期结局(在神经重症监护人群中)和认知结局(在手术队列中)的关联.这激发了人们对探索和评估最佳脑血管反应性测量方法的进一步兴趣。其中个体患者暴露于脑血管反应性受损的最低伤害负担。最近的文献记录了，在神经损伤人群中，在神经重症监护中存在潜在的最佳镇静水平，基于脑血管反应性与定量镇静深度之间的关系（使用脑电双频指数（BIS））-称为BISopt。神经损伤患者的这种措施的存在尚未得到证实。
方法：我们在两个队列中探索BIS与连续脑血管反应性之间的关系：（A）在全身麻醉下接受择期脊柱手术的健康人群，和(B)清醒对照的健康志愿者队列。
结果：我们证明了全身麻醉人群（96％的患者）中存在BISopt，以及它在清醒控制中的缺失，在神经损伤人群之外提供其存在的初步验证。此外，我们发现BIS与全身血压完全分离，这表明它们影响不同的病理生理现象来介导脑血管反应性。
结论：研究结果对个性化生理BISopt概念对非神经损伤人群的适应具有重要意义。在重症监护和手术室。然而,这项工作目前是探索性的，需要未来的工作。
方法：我们在两个队列中探索BIS与连续脑血管反应性之间的关系：（A）在全身麻醉下接受择期脊柱手术的健康人群，和(B)清醒对照的健康志愿者队列。
结果：我们证明了全身麻醉人群（96％的患者）中存在BISopt，以及它在清醒控制中的缺失，在神经损伤人群之外提供其存在的初步验证。此外，我们发现BIS与全身血压完全分离，这表明它们影响不同的病理生理现象来介导脑血管反应性。
结论：研究结果对个性化生理BISopt概念对非神经损伤人群的适应具有重要意义。在重症监护和手术室。然而,这项工作目前是探索性的，需要未来的工作。
