Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury
Critical Care Medicine,

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.

Methods
  • 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.

Results
  • 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.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Anesthesiology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Anesthesiology Articles

1 Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty?: Effect on ambulation ability, early functional recovery and pain control: A randomized controlled trial Journal of Arthroplasty, July 8, 2014    Clinical Article

2 The intubation scoop (i-scoop) - A new type of laryngoscope for difficult and normal airways Anaesthesia, June 12, 2014    Clinical Article

3 Serious adverse events associated with vasopressin and norepinephrine infusion in septic shock Critical Care Medicine, July 23, 2014    Clinical Article

4 A nomogram for calculating the maximum dose of local anaesthetic Anaesthesia, May 13, 2014    Clinical Article

5 Laryngeal mask airway placement in children prior to an intravenous line utilizing heart rate as an indicator of anesthetic depth Paediatric Anaesthesia, July 16, 2014    Clinical Article

6 Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy British Journal of Anesthesia, July 3, 2014    Clinical Article

7 The efficacy of propofol vs. subcutaneous sumatriptan for treatment of acute migraine headaches in the emergency department: a double-blinded clinical trial Pain Practice, July 15, 2014    Clinical Article

8 Adverse outcomes after total and unicompartmental knee replacement in 101 330 matched patients: a study of data from the National Joint Registry for England and Wales The Lancet, July 25, 2014    Evidence Based Medicine    Clinical Article

9 Pediatric video laryngoscope versus direct laryngoscope: A meta-analysis of randomized controlled trials Paediatric Anaesthesia, July 1, 2014    Evidence Based Medicine    Review Article

10 Carotid endarterectomy under local and/or regional anesthesia has less risk of myocardial infarction compared to general anesthesia: An analysis of National Surgical Quality Improvement Program database Vascular, July 9, 2014    Clinical Article

11 Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery JAMA, July 17, 2014    Evidence Based Medicine    Clinical Article

12 The efficacy of lidocaine to prevent laryngospasm in children: A systematic review and meta-analysis Anaesthesia, July 16, 2014    Evidence Based Medicine

13 A systematic review and meta-analysis of the i-gel vs laryngeal mask airway in adults Anaesthesia, July 10, 2014    Evidence Based Medicine

14 Association of increased postoperative opioid administration with non-small-cell lung cancer recurrence: A retrospective analysis British Journal of Anesthesia, July 14, 2014    Review Article

15 Major incidents and complications in otherwise healthy patients undergoing elective procedures: Results based on 1.36 million anaesthetic procedures British Journal of Anesthesia, May 9, 2014    Review Article

16 Comparison of clinical outcome variables in patients with and without etomidate facilitated anesthesia induction ahead of major cardiac surgery: A retrospective analysis Critical Care, July 18, 2014    Clinical Article

17 Intubation biomechanics: Laryngoscope force and cervical spine motion during intubation with Macintosh and Airtraq laryngoscopes Anesthesiology, July 30, 2014    Clinical Article

18 Comparison of palonosetron with palonosetron-dexamethasone combination for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy Full Text Minerva Anestesiologica, July 11, 2014    Free full text    Clinical Article

19 Major incidents and complications in otherwise healthy patients undergoing elective procedures: Results based on 1.37 million anaesthetic procedures British Journal of Anesthesia, June 25, 2014    Review Article

20 Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically ill patients: A meta-analysis of randomized controlled trials Journal of Cardiothoracic and Vascular Anesthesia, July 29, 2014    Evidence Based Medicine    Clinical Article

Indexed Journals in Anesthesiology: Anaesthesia, Anesthesia & Analgesia, Current Anaesthesia and Critical Caremore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close