Abstract：
BACKGROUND: Traumatic brain injury (TBI) poses a significant challenge to healthcare providers, necessitating meticulous management of hemodynamic parameters to optimize patient outcomes. This article delves into the critical task of defining and meeting continuous arterial blood pressure (ABP) and cerebral perfusion pressure (CPP) targets in the context of severe TBI in neurocritical care settings.
METHODS: We narratively reviewed existing literature, clinical guidelines, and emerging technologies to propose a comprehensive approach that integrates real-time monitoring, individualized cerebral perfusion target setting, and dynamic interventions.
RESULTS: Our findings emphasize the need for personalized hemodynamic management, considering the heterogeneity of patients with TBI and the evolving nature of their condition. We describe the latest advancements in monitoring technologies, such as autoregulation-guided ABP/CPP treatment, which enable a more nuanced understanding of cerebral perfusion dynamics. By incorporating these tools into a proactive monitoring strategy, clinicians can tailor interventions to optimize ABP/CPP and mitigate secondary brain injury.
CONCLUSIONS: Challenges in this field include the lack of standardized protocols for interpreting multimodal neuromonitoring data, potential variability in clinical decision-making, understanding the role of cardiac output, and the need for specialized expertise and customized software to have individualized ABP/CPP targets regularly available. The patient outcome benefit of monitoring-guided ABP/CPP target definitions still needs to be proven in patients with TBI.
CONCLUSIONS: We recommend that the TBI community take proactive steps to translate the potential benefits of personalized ABP/CPP targets, which have been implemented in certain centers, into a standardized and clinically validated reality through randomized controlled trials.
METHODS: We narratively reviewed existing literature, clinical guidelines, and emerging technologies to propose a comprehensive approach that integrates real-time monitoring, individualized cerebral perfusion target setting, and dynamic interventions.
RESULTS: Our findings emphasize the need for personalized hemodynamic management, considering the heterogeneity of patients with TBI and the evolving nature of their condition. We describe the latest advancements in monitoring technologies, such as autoregulation-guided ABP/CPP treatment, which enable a more nuanced understanding of cerebral perfusion dynamics. By incorporating these tools into a proactive monitoring strategy, clinicians can tailor interventions to optimize ABP/CPP and mitigate secondary brain injury.
CONCLUSIONS: Challenges in this field include the lack of standardized protocols for interpreting multimodal neuromonitoring data, potential variability in clinical decision-making, understanding the role of cardiac output, and the need for specialized expertise and customized software to have individualized ABP/CPP targets regularly available. The patient outcome benefit of monitoring-guided ABP/CPP target definitions still needs to be proven in patients with TBI.
CONCLUSIONS: We recommend that the TBI community take proactive steps to translate the potential benefits of personalized ABP/CPP targets, which have been implemented in certain centers, into a standardized and clinically validated reality through randomized controlled trials.
摘要：
背景：创伤性脑损伤（TBI）对医疗保健提供者构成了重大挑战，需要对血液动力学参数进行细致管理以优化患者预后。本文探讨了在神经重症监护环境中严重TBI的背景下，定义和满足连续动脉血压（ABP）和脑灌注压（CPP）目标的关键任务。
方法：我们对现有文献进行了述评，临床指南,和新兴技术提出了一种集成实时监控的综合方法，个体化脑灌注目标设定，和动态干预。
结果：我们的研究结果强调了个性化血流动力学管理的必要性，考虑到TBI患者的异质性和病情的演变性质。我们描述了监测技术的最新进展，如自动调节引导的ABP/CPP治疗，这使得对脑灌注动力学有了更细致的理解。通过将这些工具纳入主动监控策略，临床医生可以定制干预措施以优化ABP/CPP并减轻继发性脑损伤.
结论：该领域的挑战包括缺乏解释多模式神经监测数据的标准化方案，临床决策中的潜在变异性，了解心输出量的作用，以及需要专业知识和定制软件来定期提供个性化的ABP/CPP目标。监测指导的ABP/CPP目标定义的患者预后益处仍需要在TBI患者中得到证实。
结论：我们建议TBI社区采取积极措施，转化个性化ABP/CPP目标的潜在好处。已经在某些中心实施，通过随机对照试验进入标准化和临床验证的现实。
方法：我们对现有文献进行了述评，临床指南,和新兴技术提出了一种集成实时监控的综合方法，个体化脑灌注目标设定，和动态干预。
结果：我们的研究结果强调了个性化血流动力学管理的必要性，考虑到TBI患者的异质性和病情的演变性质。我们描述了监测技术的最新进展，如自动调节引导的ABP/CPP治疗，这使得对脑灌注动力学有了更细致的理解。通过将这些工具纳入主动监控策略，临床医生可以定制干预措施以优化ABP/CPP并减轻继发性脑损伤.
结论：该领域的挑战包括缺乏解释多模式神经监测数据的标准化方案，临床决策中的潜在变异性，了解心输出量的作用，以及需要专业知识和定制软件来定期提供个性化的ABP/CPP目标。监测指导的ABP/CPP目标定义的患者预后益处仍需要在TBI患者中得到证实。
结论：我们建议TBI社区采取积极措施，转化个性化ABP/CPP目标的潜在好处。已经在某些中心实施，通过随机对照试验进入标准化和临床验证的现实。
