Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District.
Curr Opin Crit Care. 2020 Jun;26(3):259-266. doi: 10.1097/MCC.0000000000000722.
To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics.
Observational data suggest that mean arterial pressure (MAP) below 65-75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve. Two recent randomized pilot trials compared lower and higher MAP targets during PCA care and found no significant effect on biomarkers of neurological injury. The haemodynamic interventions in those studies did not use any cerebral perfusion endpoints beyond a static MAP targets during ICU stay. Individualized, dynamic MAP targets based on assessments of cerebral perfusion and tailored to the specifics of the patient, cardiac arrest circumstances and treatment responses may be more conducive to improved outcomes. Pilot data suggest that near infrared spectroscopy monitoring may be used to determine the cerebral autoregulatory capacity and an optimal MAP, but this approach is yet to be tested in clinical trials.
Current evidence suggests targeting a MAP of at least 65-75 mmHg in PCA patients. Future studies should focus on whether certain patient groups could benefit from higher and dynamic MAP targets.
讨论与优化成年心脏骤停后患者（postcardiac arrest，PCA）血压目标相关的最新发现，并探讨是否应根据患者、心脏骤停或治疗特点对这些目标进行个体化调整。
观察性数据表明，PCA 患者的平均动脉压（mean arterial pressure，MAP）低于 65-75mmHg 与预后不良相关。对于经常出现脑自动调节曲线右移的慢性高血压患者，较高的 MAP 可能有益。两项最近的随机对照试验比较了 PCA 治疗期间较低和较高的 MAP 目标，并未发现对神经损伤生物标志物有显著影响。这些研究中的血流动力学干预措施在 ICU 期间除了使用静态 MAP 目标外，没有使用任何脑灌注终点。基于脑灌注评估和针对患者、心脏骤停情况和治疗反应的个体化、动态 MAP 目标可能更有利于改善预后。初步数据表明，近红外光谱监测可用于确定脑自动调节能力和最佳 MAP，但该方法仍有待临床试验验证。
目前的证据表明，PCA 患者的 MAP 目标应至少达到 65-75mmHg。未来的研究应重点关注某些患者群体是否可以从较高和动态的 MAP 目标中获益。
