Pressure Reactivity-Based Optimal Cerebral Perfusion Pressure in a Traumatic Brain Injury Cohort

Acta Neurochirurgica. Supplement
Joseph DonnellyPeter Smielewski

Abstract

Retrospective data from patients with severe traumatic brain injury (TBI) indicate that deviation from the continuously calculated pressure reactivity-based "optimal" cerebral perfusion pressure (CPPopt) is associated with worse patient outcome. The objective of this study was to assess the relationship between prospectively collected CPPopt data and patient outcome after TBI. We prospectively collected intracranial pressure (ICP) monitoring data from 231 patients with severe TBI at Addenbrooke's Hospital, UK. Uncleaned arterial blood pressure and ICP signals were recording using ICM+® software on dedicated bedside computers. CPPopt was determined using an automatic curve fitting procedure of the relationship between pressure reactivity index (PRx) and CPP using a 4-h window, as previously described. The difference between an instantaneous CPP value and its corresponding CPPopt value was denoted every minute as ΔCPPopt. A negative ΔCPPopt that was associated with impaired PRx (>+0.15) was denoted as being below the lower limit of reactivity (LLR). Glasgow Outcome Scale (GOS) score was assessed at 6 months post-ictus. When ΔCPPopt was plotted against PRx and stratified by GOS groupings, data belonging to patients with a more unf...Continue Reading

Citations

Jul 18, 2018·Current Opinion in Anaesthesiology·Boris D HeifetsMark A Burbridge
Dec 14, 2018·Nature Reviews. Neurology·Frederick A ZeilerDavid K Menon
Sep 10, 2019·Stroke; a Journal of Cerebral Circulation·Andrew SilvermanNils H Petersen
Apr 27, 2021·Neurologic Clinics·Courtney E TakahashiAnna M Cervantes-Arslanian

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