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Novel Noninvasive Methods of Intracranial Pressure and Cerebrovascular Autoregulation Assessment: Seeing the Brain Through the Eyes


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Traumatic brain injury (TBI) plays a major role in approximately 30% of injury related civilian deaths in the U.S. The Defense and Veterans Brain Injury Center (DVBIC) has reported over 34,000 moderate to severe combat-related TBI (CRTBI) since 2000, making it a major source of mortality and morbidity for the U.S. military between 2000 and 2016. The significance of such numbers becomes apparent with the militarys increased focus on Prolonged Field Care (PFC) and prolonged damage control resuscitation (pDCR). PFC is field medical care, applied beyond doctrinal planning time-lines by a SOCM (Special Operations Combat Medic) or higher, in order to decrease patient mortality and morbidity, utilize limited resources, and provide sustained care until the patient arrives at an appropriate level of care. One of the significant management strategies in the treatment of TBI is aimed at preventing secondary brain damage, which mainly manifests itself as brain ischemia and inflammation. Monitoring of intracranial pressure (ICP) and cerebral autoregulation (CAR) to optimize cerebral perfusion pressure (CPP) to a target and maintain cerebral blood flow (CBF) are the primary methods to prevent secondary injury and are the mainstays of current practice. In a recent study, Juul et al. has concluded that acute neurological deterioration is a powerful predictor of poor outcomes following TBI. The study showed that 29% of patients with acute neurological decline having an unfavorable outcome and the most powerful predictor of such neurological deterioration was the patients measured ICP. Therefore, it is critical to be able to monitor and manage ICP as early as possible following TBI. Current guidelines of the Brain Trauma Foundation recommend the use of invasive ICP monitoring in patients who meet specific criteria, with the aim of achieving significant reduction in mortality in civilian centers.



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