Optimal Cerebral Perfusion Pressure: Targeted Treatment for Severe Traumatic Brain Injury

Vytautas Petkus*, Aidanas Preiksaitis, Edvinas Chaleckas, Romanas Chomskis, Erika Zubaviciute, Saulius Vosylius, Saulius Rocka, Daiva Rastenyte, Marcel J. Aries, Arminas Ragauskas, Jan-Oliver Neumann

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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.

Original languageEnglish
Pages (from-to)389-396
Number of pages8
JournalJournal of Neurotrauma
Volume37
Issue number2
Early online date13 Nov 2019
DOIs
Publication statusPublished - 15 Jan 2020

Keywords

  • cerebrovascular autoregulation
  • critical care
  • optimal cerebral perfusion pressure
  • pressure reactivity index
  • traumatic brain injury
  • AUTOREGULATION
  • REACTIVITY
  • OUTCOMES
  • INDEX

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