Newly Published
Review Article  |   April 2017
Cerebral Autoregulation-oriented Therapy at the Bedside: A Comprehensive Review
Author Notes
  • From the Departments of Neurology (L.R.-L., R.G.G., W.Z., M.A.M.) and Anesthesiology and Critical Care Medicine (L.R.-L., A.Z.-V., R.G.G., R.J.H., W.Z., M.A.M.), Johns Hopkins School of Medicine, Baltimore, Maryland; and School of Medicine, Faculty of Health, Universidad del Valle, Cali, Colombia (A.Z.-V.).
  • Figures 1 and 2 were enhanced by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina.
    Figures 1 and 2 were enhanced by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina.×
  • Submitted for publication March 25, 2016. Accepted for publication February 21, 2017.
    Submitted for publication March 25, 2016. Accepted for publication February 21, 2017.×
  • Research Support: Supported by grants from the American Academy of Neurology/American Brain Foundation, Minneapolis, Minnesota, and Medtronic/Covidien, Dublin, Ireland (to Dr. Rivera-Lara).
    Research Support: Supported by grants from the American Academy of Neurology/American Brain Foundation, Minneapolis, Minnesota, and Medtronic/Covidien, Dublin, Ireland (to Dr. Rivera-Lara).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Rivera-Lara: Departments of Neurology and Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 N. Wolfe St., Phipps 455, Baltimore, Maryland 21287. lriver14@jhmi.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Review Article / Central and Peripheral Nervous Systems / Endocrine and Metabolic Systems
Review Article   |   April 2017
Cerebral Autoregulation-oriented Therapy at the Bedside: A Comprehensive Review
Anesthesiology Newly Published on April 13, 2017. doi:10.1097/ALN.0000000000001625
Anesthesiology Newly Published on April 13, 2017. doi:10.1097/ALN.0000000000001625
Abstract

This comprehensive review summarizes the evidence regarding use of cerebral autoregulation-directed therapy at the bedside and provides an evaluation of its impact on optimizing cerebral perfusion and associated functional outcomes. Multiple studies in adults and several in children have shown the feasibility of individualizing mean arterial blood pressure and cerebral perfusion pressure goals by using cerebral autoregulation monitoring to calculate optimal levels. Nine of these studies examined the association between cerebral perfusion pressure or mean arterial blood pressure being above or below their optimal levels and functional outcomes. Six of these nine studies (66%) showed that patients for whom median cerebral perfusion pressure or mean arterial blood pressure differed significantly from the optimum, defined by cerebral autoregulation monitoring, were more likely to have an unfavorable outcome. The evidence indicates that monitoring of continuous cerebral autoregulation at the bedside is feasible and has the potential to be used to direct blood pressure management in acutely ill patients.