Islam Abrar, Marquez Izabella, Froese Logan, Vakitbilir Nuray, Gomez Alwyn, Stein Kevin Y, Bergmann Tobias, Sainbhi Amanjyot Singh, Zeiler Frederick A
Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Canada.
Undergraduate Engineering, Biosystems Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Canada.
Neurotrauma Rep. 2024 Sep 13;5(1):813-823. doi: 10.1089/neur.2024.0058. eCollection 2024.
Acute traumatic neural injury, known as traumatic brain injury (TBI), stands as a significant contributor to global mortality and disability. Ideally, continuously monitoring cerebral compliance/cerebral compensatory reserve would enable timely interventions and avert further substantial deterioration in TBI cases. RAP, defined as the moving Pearson's correlation between intracranial pressure (ICP) pulse amplitude waveform and ICP, has been proposed as a continuously updating index in this context. However, the literature remains scattered and difficult to navigate. Thus, the goal of this scoping review was to comprehensively characterize the literature regarding RAP and its association with (1) other multimodal cerebral physiological monitoring, (2) neuroimaging features, and (3) long-term patient outcomes. We subsequently conducted a systematic scoping review of the human literature to highlight the association of RAP with continuous multimodal monitoring of cerebral physiology, neuroimaging, and patient outcomes in the context of adult TBI patients. Our review encompassed 21 studies focusing on these topics. The primary findings involve meticulous analysis of studies, categorizing findings into three states of RAP to clearly understand its relation to cerebral physiology and clinical outcomes. State 1 signifies a healthy condition with a small positive value near zero (RAP <0.5). Conversely, state 2, a predominant characterization of TBI patients, indicates compromised compensatory reserve, featuring a large positive RAP value (RAP > 0.4). State 3 emerges in worsened conditions, showcasing further compromised compensatory reserve, exhausted cerebrovascular reactivity, and disturbed cerebral autoregulation. A substantial number of patients with fatal outcomes was found in state 3, marked by a notable occurrence of decreasing and, in some instances, negative RAP. The significance of this review lies in establishing a platform for future research directions to enhance the precision and clinical implications of RAP in TBI care, ultimately aiming to prevent the transition from state 2 to state 3 and mitigate fatal outcomes.
急性创伤性神经损伤，即创伤性脑损伤（TBI），是全球死亡率和残疾率的重要促成因素。理想情况下，持续监测脑顺应性/脑代偿储备能够实现及时干预，并避免TBI病例进一步严重恶化。RAP被定义为颅内压（ICP）脉搏振幅波形与ICP之间的移动皮尔逊相关性，在此背景下被提议作为一个持续更新的指标。然而，相关文献仍然分散，难以梳理。因此，本范围综述的目的是全面描述关于RAP及其与（1）其他多模态脑生理监测、（2）神经影像学特征和（3）患者长期预后之间关联的文献。随后，我们对人类文献进行了系统的范围综述，以突出在成年TBI患者背景下RAP与脑生理、神经影像学的持续多模态监测以及患者预后之间的关联。我们的综述涵盖了21项关注这些主题的研究。主要发现包括对研究的细致分析，将发现分为RAP的三种状态，以清楚地了解其与脑生理和临床结果的关系。状态1表示健康状态，接近零的小正值（RAP<0.5）。相反，状态2是TBI患者的主要特征，表明代偿储备受损，具有较大的正RAP值（RAP>0.4）。状态3出现在病情恶化的情况下，表现为代偿储备进一步受损、脑血管反应性耗尽和脑自动调节紊乱。在状态3中发现大量患者出现致命结局，其特征是RAP显著下降，在某些情况下为负值。本综述的意义在于为未来的研究方向建立一个平台，以提高RAP在TBI护理中的准确性和临床意义，最终目标是防止从状态2转变为状态3并减轻致命结局。
