TY - JOUR
T1 - Arterial pressure and cerebral blood flow variability
T2 - Friend or foe? A review
AU - Rickards, Caroline A.
AU - Tzeng, Yu Chieh
PY - 2014
Y1 - 2014
N2 - Variability in arterial pressure and cerebral blood flow has traditionally been interpreted as a marker of cardiovascular decompensation, and has been associated with negative clinical outcomes across varying time scales, from impending orthostatic syncope to an increased risk of stroke. Emerging evidence, however, suggests that increased hemodynamic variability may, in fact, be protective in the face of acute challenges to perfusion, including significant central hypovolemia and hypotension (including hemorrhage), and during cardiac bypass surgery. This review presents the dichotomous views on the role of hemodynamic variability on clinical outcome, including the physiological mechanisms underlying these patterns, and the potential impact of increased and decreased variability on cerebral perfusion and oxygenation. We suggest that reconciliation of these two apparently discrepant views may lie in the time scale of hemodynamic variability; short time scale variability appears to be cerebroprotective, while mid to longer term fluctuations are associated with primary and secondary end-organ dysfunction.
AB - Variability in arterial pressure and cerebral blood flow has traditionally been interpreted as a marker of cardiovascular decompensation, and has been associated with negative clinical outcomes across varying time scales, from impending orthostatic syncope to an increased risk of stroke. Emerging evidence, however, suggests that increased hemodynamic variability may, in fact, be protective in the face of acute challenges to perfusion, including significant central hypovolemia and hypotension (including hemorrhage), and during cardiac bypass surgery. This review presents the dichotomous views on the role of hemodynamic variability on clinical outcome, including the physiological mechanisms underlying these patterns, and the potential impact of increased and decreased variability on cerebral perfusion and oxygenation. We suggest that reconciliation of these two apparently discrepant views may lie in the time scale of hemodynamic variability; short time scale variability appears to be cerebroprotective, while mid to longer term fluctuations are associated with primary and secondary end-organ dysfunction.
KW - Blood pressure variability
KW - Cerebral blood flow (CBF)
KW - Cerebral blood flow variability
KW - End organ damage
KW - Hemodynamic oscillations
UR - http://www.scopus.com/inward/record.url?scp=84901058055&partnerID=8YFLogxK
U2 - 10.3389/fphys.2014.00120
DO - 10.3389/fphys.2014.00120
M3 - Review article
AN - SCOPUS:84901058055
SN - 1664-042X
VL - 5 APR
JO - Frontiers in Physiology
JF - Frontiers in Physiology
M1 - Article 120
ER -