Publisher

INASNACCINASNACC

Journal Jurnal neuroanestesi indonesiaJurnal neuroanestesi indonesia Abstract

Two common factors contributing to poorer outcomes in TBI patients are high intracranial pressure (ICP) and low cerebral perfusion pressure (CPP). These two factors constitute a vicious circle that will have a negative impact on TBI patients. An increase in ICP will cause a decrease in CPP, while a reduction in CPP will cause ischemia, which will worsen the high ICP. However, increasing the CPP by increasing MAP will not help the situation; in fact, it may worsen the impact due to impairment of cerebral autoregulation (CA). Therefore, it is critical to manage TBI patients with an ideal CPP. Pressure reactivity index (PRx) is a measurement of the linear relationship between the mean arterial pressure (MAP) and ICP. A positive correlation between ICP and MAP indicates an impairment of CA, which suggests a suboptimal CPP value. The basis of PRx theory is that the rise, because of the presence of CA, an increase in MAP should not be followed by the rise in ICP because there is a compensatory effect in the form of a decrease in cerebral blood volume, so that ICP does not increase. That being said, this mechanism will not work when the limit of autoregulation is exceeded. Based on PRx and CPP, an optimal CPP could be obtained by using a U-shaped curve. The outcomes of TBI patients can be enhanced by treating them according to their optimal CPP (CPPopt).

Conclusion

Pressure reactivity index (PRx) is a relationship between MAP and ICP derived from dynamic, slow variations in cerebral blood volume (CBV) by cerebral autoregulation.The U-shaped curves of PRx and CPP can help determine CPPopt values.Numerous studies have demonstrated that the PRx value is correlated with the outcome of TBI patients and that controlling CPP between CPPopt can improve the outcome of TBI patients.

Future Research

Penelitian lebih lanjut perlu dilakukan untuk mengeksplorasi penggunaan PRx dalam populasi TBI yang lebih luas dan beragam, termasuk mempertimbangkan perbedaan usia dan tingkat keparahan cedera. Studi prospektif yang lebih besar dan terstruktur dengan baik diperlukan untuk mengkonfirmasi manfaat klinis dari terapi berbasis CPPopt yang dipandu oleh PRx, dengan fokus pada perbandingan hasil neurologis jangka panjang dan kualitas hidup pasien. Selain itu, penelitian di masa depan dapat berfokus pada pengembangan algoritma otomatis dan sistem pengambilan keputusan klinis yang mengintegrasikan data PRx dengan parameter fisiologis lainnya untuk memberikan panduan yang lebih personal dan tepat waktu dalam pengelolaan pasien TBI.

References

1. Pressure Reactivity Index (PRx): A Concept to Optimize Cerebral Perfusion Pressure in Traumatic Brain... inasnacc.org/ojs2/index.php/jni/article/view/693Pressure Reactivity Index PRx A Concept to Optimize Cerebral Perfusion Pressure in Traumatic Brain inasnacc ojs2 index php jni article view 693

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