TY - JOUR
T1 - Optimal Cerebral Perfusion Pressure
T2 - Targeted Treatment for Severe Traumatic Brain Injury
AU - Petkus, Vytautas
AU - Preiksaitis, Aidanas
AU - Chaleckas, Edvinas
AU - Chomskis, Romanas
AU - Zubaviciute, Erika
AU - Vosylius, Saulius
AU - Rocka, Saulius
AU - Rastenyte, Daiva
AU - Aries, Marcel J.
AU - Ragauskas, Arminas
AU - Neumann, Jan-Oliver
N1 - Funding Information:
This research was supported by the Research Council of Lithuania (grant no.: MIP-087/2015) and European Commission FP7-HEALTH (grant no.: 602150).
Publisher Copyright:
© Copyright 2020, Mary Ann Liebert, Inc., publishers.
PY - 2020/1/15
Y1 - 2020/1/15
N2 - Identification of individual therapy targets is critical for traumatic brain injury (TBI) patients. Clinical outcomes depend on cerebrovascular autoregulation (CA) impairment. Here, we compare the effectiveness of optimal cerebral perfusion pressure (CPPopt)-targeted therapy in younger (= 45 years of age) TBI patients. Single-center multi-modal invasive arterial blood pressure(t), intracranial pressure (ICP)(t), cerebral perfusion pressure CPP(t), and CPPopt(t) monitoring (n = 81) was performed. ICM+ software was used for continuous CPPopt(t) status assessment by identification of pressure reactivity index (PRx). The most significant prognostic factors were age, Glasgow Coma Scale, serum glucose, and duration of longest CA ompairment event (LCAI) when PRx(t) >0.5 within 24 h after admission. The modeled accuracies for favorable and unfavorable outcome prediction were 86.5% and 90.9%, respectively. Age above 45 years and averaged ICP during all monitoring time above 21.3 mm Hg was associated with unfavorable outcome of an individual patient. Averaged CPP values close to CPPopt were associated with a better outcome in younger patients. Averaged Delta CPPopt 0.36, and LCAI >100 min were significantly associated with mortality for the younger patients. The critical values of averaged PRx >0.26 and LCAI >61 min were significantly associated with mortality for the elderly group. Autoregulation-guided treatment was important for individual TBI management, especially in younger patients. Further randomized multi-center studies are needed to prove final benefit.
AB - Identification of individual therapy targets is critical for traumatic brain injury (TBI) patients. Clinical outcomes depend on cerebrovascular autoregulation (CA) impairment. Here, we compare the effectiveness of optimal cerebral perfusion pressure (CPPopt)-targeted therapy in younger (= 45 years of age) TBI patients. Single-center multi-modal invasive arterial blood pressure(t), intracranial pressure (ICP)(t), cerebral perfusion pressure CPP(t), and CPPopt(t) monitoring (n = 81) was performed. ICM+ software was used for continuous CPPopt(t) status assessment by identification of pressure reactivity index (PRx). The most significant prognostic factors were age, Glasgow Coma Scale, serum glucose, and duration of longest CA ompairment event (LCAI) when PRx(t) >0.5 within 24 h after admission. The modeled accuracies for favorable and unfavorable outcome prediction were 86.5% and 90.9%, respectively. Age above 45 years and averaged ICP during all monitoring time above 21.3 mm Hg was associated with unfavorable outcome of an individual patient. Averaged CPP values close to CPPopt were associated with a better outcome in younger patients. Averaged Delta CPPopt 0.36, and LCAI >100 min were significantly associated with mortality for the younger patients. The critical values of averaged PRx >0.26 and LCAI >61 min were significantly associated with mortality for the elderly group. Autoregulation-guided treatment was important for individual TBI management, especially in younger patients. Further randomized multi-center studies are needed to prove final benefit.
KW - cerebrovascular autoregulation
KW - critical care
KW - optimal cerebral perfusion pressure
KW - pressure reactivity index
KW - traumatic brain injury
KW - AUTOREGULATION
KW - REACTIVITY
KW - OUTCOMES
KW - INDEX
U2 - 10.1089/neu.2019.6551
DO - 10.1089/neu.2019.6551
M3 - Article
C2 - 31583962
SN - 0897-7151
VL - 37
SP - 389
EP - 396
JO - Journal of Neurotrauma
JF - Journal of Neurotrauma
IS - 2
ER -