Lassen’s Cerebral Autoregulation Plot Revisited and Validated 65 Years Later: Impacts of Vasoactive Drug Treatment on Cerebral Blood Flow

医学 脑自动调节 脑血流 脑灌注压 自动调节 血压 麻醉 背景(考古学) 颅内压 血管活性 重症监护医学 心脏病学 内科学 生物 古生物学
作者
Lingzhong Meng,Yanhua Sun,Mads Rasmussen,Nicole Bianca S. Libiran,Semanti Naiken,Kylie S. Meacham,Jacob Schmidt,Niloy K. Lahiri,Jiange Han,Ziyue Liu,David C. Adams,Adrian W. Gelb
出处
期刊:Anesthesia & Analgesia [Lippincott Williams & Wilkins]
被引量:2
标识
DOI:10.1213/ane.0000000000007280
摘要

Niels Lassen’s seminal 1959 cerebral autoregulation plot, a cornerstone in understanding the relationship between mean arterial pressure (MAP) and cerebral blood flow (CBF), was based on preexisting literature. However, this work has faced criticism for selective data presentation, leading to inaccurate interpretation. This review revisits and validates Lassen’s original plot using contemporary data published since 2000. Additionally, we aim to understand the impact of vasoactive drug treatments on CBF, as Lassen’s referenced studies used various drugs for blood pressure manipulation. Our findings confirm Lassen’s concept of a plateau where CBF remains relatively stable across a specific MAP range in awake humans with normal brains. However, significant variations in cerebral autoregulation among different populations are evident. In critically ill patients and those with traumatic brain injury, the autoregulatory plateau dissipates, necessitating tight blood pressure control to avoid inadequate or excessive cerebral perfusion. A plateau is observed in patients anesthetized with intravenous agents but not with volatile agents. Vasopressor treatments have population-dependent effects, with contemporary data showing increased CBF in critically ill patients but not in awake humans with normal brains. Vasopressor treatment results in a greater increase in CBF during volatile than intravenous anesthesia. Modern antihypertensives do not significantly impact CBF based on contemporary data, exerting a smaller impact on CBF compared to historical data. These insights underscore the importance of individualized blood pressure management guided by modern data in the context of cerebral autoregulation across varied patient populations.
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