Abstract:

Regulation of the cerebral blood flow relies on the complex interplay between cardiovascular, respiratory, and neural physiology. The precise regulation of cerebral blood flow is critical for maintenance of constant nutrient and oxygen supply to the brain, protecting the brain from ischemia or hyperemia. The mechanism of regulation of cerebral blood flow, including cardiac output regulation, cerebral autoregulation, carbon dioxide reactivity, neuroregulation, and neurovascular coupling, is multifactorial, but all of them must act on the cerebral circulation. The pathophysiology of acute brain injury is complex and diverse, which involves the disorder of cerebral arterial pressure, cerebral blood flow, and cerebral metabolism. The disorder of these parameters leads to the impairment of cerebral blood flow regulation, thus aggravating the brain injury. Monitoring regulation of cerebral blood flow is important in the treatment of acute brain injury. Regulation of cerebral blood flow can be realized by continuous dynamic bedside monitoring. The core principles for the treatment of acute brain injury are optimizing cardiac output, ensuring cerebral perfusion, optimizing cerebral metabolism and neuronal activity, finding appropriate cerebral arterial pressure to match cerebral blood flow through cerebral autoregulation, and optimizing pressure of arterial carbon dioxide to provide optimal vascular reserve.

Key words: Acute brain injury, Cerebral autoregulation, Carbon dioxide reactivity, Neuroregulation, Neurovascular coupling