Impaired cerebrovascular reactivity in adult moderate and severe traumatic brain injury (TBI) is known to be associated with worse global outcome at 6-12 months. As technology has improved over the past decades, monitoring of cerebrovascular reactivity has shifted from intermittent measures, to experimentally validated continuously updating indices at the bedside. Such advances have led to the exploration of individualised physiologic targets in adult TBI management, such as optimal cerebral perfusion pressure (CPP) values, or CPP limits in which vascular reactivity is relatively intact. These targets have been shown to have a stronger association with outcome compared with existing consensus-based guideline thresholds in severe TBI care. This has sparked ongoing prospective trials of such personalised medicine approaches in adult TBI. In this narrative review paper, we focus on the concept of cerebral autoregulation, proposed mechanisms of control and methods of continuous monitoring used in TBI. We highlight multimodal cranial monitoring approaches for continuous cerebrovascular reactivity assessment, physiologic and neuroimaging correlates, and associations with outcome. Finally, we explore the recent 'state-of-the-art' advances in personalised physiologic targets based on continuous cerebrovascular reactivity monitoring, their benefits, and implications for future avenues of research in TBI.

中文翻译：

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在中度/重度颅脑损伤中连续进行脑血管反应性监测：对神经重症监护进展的叙述性综述。

成人中度和重度创伤性脑损伤（TBI）中脑血管反应性受损与6-12个月的整体预后差有关。在过去的几十年中，随着技术的进步，对脑血管反应性的监测已从间歇性措施转变为在床旁经过实验验证的不断更新指标。此类进展已导致对成人TBI管理中个体化的生理指标的探索，例如最佳的脑灌注压力（CPP）值或血管反应相对完整的CPP限值。与现有的在重型TBI护理中基于共识的指南阈值相比，这些目标已显示出与结局的更强关联。这已经引发了在成人TBI中进行此类个性化医学方法的正在进行的前瞻性试验。在这篇叙述性综述文章中，我们重点介绍了脑自动调节的概念，提出的控制机制和TBI中使用的连续监测方法。我们着重介绍用于连续脑血管反应性评估，生理和神经影像学相关性以及与结果关联的多模式颅骨监测方法。最后，我们基于连续的脑血管反应性监测，其益处以及对TBI未来研究途径的意义，探索了个性化生理指标的最新“最新技术”进展。生理和神经影像相关，并与结果相关。最后，我们基于连续的脑血管反应性监测，其益处以及对TBI未来研究途径的意义，探索了个性化生理指标的最新“最新技术”进展。生理和神经影像相关，并与结果相关。最后，我们基于连续的脑血管反应性监测，其益处以及对TBI未来研究途径的意义，探索了个性化生理指标的最新“最新技术”进展。