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The Lower Limit of Reactivity as a potential individualised Cerebral Perfusion Pressure target in Traumatic Brain Injury: a CENTER-TBI High-Resolution Sub-Study Analysis

Published version
Peer-reviewed

Repository DOI


Change log

Authors

Beqiri, Erta 
Zeiler, Frederick 
Ercole, Ari 
Placek, Michal 
Tas, Jeanette 

Abstract

Background: A previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR), is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multi-centre cohort. Methods: Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7 days period), Kruskal-Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong’s Test. Results: Average LLR over the first 7 days was above 60mmHg in 48% of patients. %time with CPP<LLR could predict mortality (AUC 0.73, p=<0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP. Conclusions: Using a multi-centre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.

Description

Funder: CTBI scholarship; Grant(s): EC grant n°:602150


Funder: Gates Cambridge Scholarship


Funder: NSERC


Funder: Canadian Institutes of Health Research


Funder: MPI Neuroscience Research Operating Fund


Funder: Health Sciences Centre Foundation Winnipeg


Funder: University of Manitoba MPI Professorship in Neuroscience


Funder: HersenStrijd fonds


Funder: Neurological Foundation of New Zealand; doi: http://dx.doi.org/10.13039/501100001543


Funder: NIHR Cambridge Biomedical Research Centre; doi: http://dx.doi.org/10.13039/501100018956


Funder: ZNS - Hannelore Kohl Stiftung; doi: http://dx.doi.org/10.13039/501100007731


Funder: OneMind


Funder: Integra LifeSciences; doi: http://dx.doi.org/10.13039/100009006

Keywords

Cerebral autoregulation, Individualised cerebral perfusion pressure, Lower limit of reactivity, Traumatic brain injury, Humans, Retrospective Studies, Cerebrovascular Circulation, Brain Injuries, Traumatic, Logistic Models, Area Under Curve, Intracranial Pressure

Journal Title

Critical Care

Conference Name

Journal ISSN

1364-8535
1466-609X

Volume Title

27

Publisher

BMC
Sponsorship
MRC (2431116)
European Commission (602150)
Medical Research Council (grant no.: MR N013433-1); Gates Cambridge trust