Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Single Breath, Inc., Midlothian, Virginia, USA.
J Neurotrauma. 2020 Nov 15;37(22):2401-2413. doi: 10.1089/neu.2018.6145. Epub 2019 Feb 25.
Traumatic brain injury (TBI) is often associated with long-term disability and chronic neurological sequelae. One common contributor to unfavorable outcomes is secondary brain injury, which is potentially treatable and preventable through appropriate management of patients in the neurosurgical intensive care unit. Intracranial pressure (ICP) is currently the predominant neurological-specific physiological parameter used to direct the care of severe TBI (sTBI) patients. However, recent clinical evidence has called into question the association of ICP monitoring with improved clinical outcome. The detailed cellular and molecular derangements associated with intracranial hypertension (IC-HTN) and their relationship to injury phenotype and neurological outcomes are not completely understood. Various animal models of TBI have been developed, but the clinical applicability of ICP monitoring in the pre-clinical setting has not been well-characterized. Linking basic mechanistic studies in translational TBI models with investigation of ICP monitoring that more faithfully replicates the clinical setting will provide clinical investigators with a more informed understanding of the pathophysiology of IC-HTN, thus facilitating development of improved therapies for sTBI patients.
创伤性脑损伤（TBI）常导致长期残疾和慢性神经后遗症。继发性脑损伤是导致不良预后的一个常见因素，通过在神经外科重症监护病房对患者进行适当的管理，继发性脑损伤是可以治疗和预防的。颅内压（ICP）目前是指导严重 TBI（sTBI）患者治疗的主要神经特异性生理参数。然而，最近的临床证据质疑 ICP 监测与改善临床结果之间的关联。与颅内高压（IC-HTN）相关的详细细胞和分子紊乱及其与损伤表型和神经结局的关系尚不完全清楚。已经开发了各种 TBI 动物模型，但 ICP 监测在临床前环境中的临床适用性尚未得到很好的描述。将转化性 TBI 模型中的基础机制研究与更真实地复制临床环境的 ICP 监测研究联系起来，将为临床研究人员提供对 IC-HTN 病理生理学的更深入了解，从而促进为 sTBI 患者开发更好的治疗方法。
