Journal
CRITICAL CARE MEDICINE
Volume 40, Issue 8, Pages 2456-2463Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0b013e3182514eb6
Keywords
cerebral perfusion pressure; cerebrovascular pressure reactivity; intracranial pressure; longitudinal recording clinical outcome; traumatic brain injury
Categories
Funding
- European Federation of Neurological Societies (EFNS)
- Netherlands Organisation for Health Research and Development
- Swiss National Science Foundation
- National Institute for Health Research (NIHR)
- Raymond and Beverly Sackler Studentship
- Academy of Medical Sciences/Health Foundation
- Medical Research Council/NIHR
- Medical Research Council
- NIHR Cambridge Biomedical Centre
- NIHR Senior Investigator award
- Addenbrooke's Hospital Neurocritical Care Unit
- Academic Neurosurgical Unit
- Medical Research Council [G0001354B, G9439390, G0600986, G0001354, G1000183B, G0601025, G0001237] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0508-10327, ACF-2011-14-003] Funding Source: researchfish
- MRC [G9439390, G0001237, G0600986, G0601025] Funding Source: UKRI
Ask authors/readers for more resources
Objectives: We have sought to develop an automated methodology for the continuous updating of optimal cerebral perfusion pressure (CPPopt) for patients after severe traumatic head injury, using continuous monitoring of cerebrovascular pressure reactivity. We then validated the CPPopt algorithm by determining the association between outcome and the deviation of actual CPP from CPPopt. Design: Retrospective analysis of prospectively collected data. Setting: Neurosciences critical care unit of a university hospital. Patients: A total of 327 traumatic head-injury patients admitted between 2003 and 2009 with continuous monitoring of arterial blood pressure and intracranial pressure. Measurements and Main Results: 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 60 mm Hg and 70 mm Hg were also related to outcome, these relationships were less robust. Conclusions: Real-time 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. (Crit Care Med 2012; 40:2456-2463)
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available