Key-points of cerebral hemodynamic therapy in neuro critical cases / 中国实用内科杂志

ABSTRACT

Cerebral hemodynamic therapy has the ultimate goal of brain function improvements.The therapeutic endpoint is to optimize cerebral perfusion in order to stop primary or secondary injury and promote brain function recovery.Clinically,cerebral perfusion can be indirectly measured by brain oxygenation instruments including Near-infrared spectroscopy.Cerebral blood flow optimization should be the core target of cerebral hemodynamic therapy.Transcranial Color-Coded Duplex and Transcranial Doppler sonography are essential techniques to quantify cerebral blood flow,evaluate vascular resistance,and alert for increased intracranial pressure non-invasively by bedside measurements of optic nerve sheath diameter.Hemodynamic targets including blood pressure,cardiac output,and oxygen delivery require extra considerations beyond traditional hemodynamic therapy in order to promote cerebral function.Brain electricity monitoring should be read with caution where low brain activity might indicate insufficient cerebral perfusion,whereas overactive brain function shows high oxygen consumption.In clinical practice,the integrated monitoring of cerebral blood flow,brain oxygenation and brain function would improve the management of neurocritical patients.