Pressure Reactivity-Based Optimal Cerebral Perfusion Pressure in a Traumatic Brain Injury Cohort.
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Authors
Adams, H
Robba, C
Steiner, LA
Cardim, D
Cabella, B
Liu, X
Aries, MJH
Publication Date
2018Journal Title
Acta Neurochir Suppl
ISSN
0065-1419
Publisher
Springer International Publishing
Volume
126
Pages
209-212
Language
eng
Type
Article
This Version
AM
Physical Medium
Print
Metadata
Show full item recordCitation
Donnelly, J., Czosnyka, M., Adams, H., Robba, C., Steiner, L., Cardim, D., Cabella, B., et al. (2018). Pressure Reactivity-Based Optimal Cerebral Perfusion Pressure in a Traumatic Brain Injury Cohort.. Acta Neurochir Suppl, 126 209-212. https://doi.org/10.1007/978-3-319-65798-1_43
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: When ΔCPPopt was plotted against PRx and stratified by GOS groupings, data belonging to patients with a more unfavourable outcome had a U-shaped curve that shifted upwards. More time spent with a ΔCPPopt value below the LLR was positively associated with mortality (area under the receiver operating characteristic curve = 0.76 [0.68-0.84]). CONCLUSIONS: In a recent cohort of patients with severe TBI, the time spent with a CPP below the CPPopt-derived LLR is related to mortality. Despite aggressive CPP- and ICP-oriented therapies, TBI patients with a fatal outcome spend a significant amount of time with a CPP below their individualised CPPopt, indicating a possible therapeutic target.
Keywords
Humans, Monitoring, Physiologic, Trauma Severity Indices, Glasgow Outcome Scale, Retrospective Studies, Cohort Studies, Cerebrovascular Circulation, Intracranial Pressure, Adult, Disease Management, Female, Male, Arterial Pressure, Brain Injuries, Traumatic
Sponsorship
Medical Research Council (G0600986)
Medical Research Council (G0601025)
Medical Research Council (G1002277)
NETSCC (None)
NETSCC (None)
TCC (None)
Identifiers
External DOI: https://doi.org/10.1007/978-3-319-65798-1_43
This record's URL: https://www.repository.cam.ac.uk/handle/1810/274025
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