Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury
Critical Care Medicine, 08/03/2012
Aries MJH et al. – Real–time optimal cerebral perfusion pressure (CPPopt) could be identified during the recording time of majority of the patients. Patients with a median CPP close to CPPopt were more likely to have a favorable outcome than those in whom median CPP was widely different from CPPopt. Deviations from individualized CPPopt were more predictive of outcome than deviations from a common target CPP. CPP management to optimize cerebrovascular pressure reactivity should be the subject of future clinical trial in severe traumatic head–injury patients.
A total of 327 traumatic head-injury patients admitted between 2003 and 2009 with continuous monitoring of arterial blood pressure and intracranial pressure.
Arterial blood pressure, intracranial pressure, and CPP were continuously recorded, and pressure reactivity index was calculated online.
Outcome was assessed at 6 months.
An automated curve fitting method was applied to determine CPP at the minimum value for pressure reactivity index (CPPopt).
A time trend of CPPopt was created using a moving 4-hr window, updated every minute.
Identification of CPPopt was, on average, feasible during 55% of the whole recording period.
Patient outcome correlated with the continuously updated difference between median CPP and CPPopt (chi-square=45, p<.001; outcome dichotomized into fatal and nonfatal).
Mortality was associated with relative “hypoperfusion” (CPP<CPPopt), severe disability with “hyperperfusion” (CPP>CPPopt), and favorable outcome was associated with smaller deviations of CPP from the individualized CPPopt.
While deviations from global target CPP values of 60mmHg and 70mmHg were also related to outcome, these relationships were less robust.
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