Benefit on optimal cerebral perfusion pressure targeted treatment for traumatic brain injury patients

Vytautas Petkus; Aidanas Preiksaitis; Solventa Krakauskaite; Erika Zubaviciute; Saulius Rocka; Daiva Rastenyte; Saulius Vosylius; Arminas Ragauskas

doi:10.1016/j.jcrc.2017.04.029

Benefit on optimal cerebral perfusion pressure targeted treatment for traumatic brain injury patients

J Crit Care. 2017 Oct:41:49-55. doi: 10.1016/j.jcrc.2017.04.029. Epub 2017 Apr 23.

Authors

Vytautas Petkus¹, Aidanas Preiksaitis², Solventa Krakauskaite³, Erika Zubaviciute⁴, Saulius Rocka⁵, Daiva Rastenyte⁶, Saulius Vosylius⁵, Arminas Ragauskas¹

Affiliations

¹ Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania.
² Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania; Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Lithuania; Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania.
³ Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania. Electronic address: solventa@mail.com.
⁴ Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁵ Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania.
⁶ Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Lithuania.

PMID: 28477510
DOI: 10.1016/j.jcrc.2017.04.029

Abstract

Purpose: The maintenance of patient-specific optimal cerebral perfusion pressure (CPPopt) is crucial for patients with traumatic brain injury (TBI). The goal of the study was to explore the influence of CPP declination from CPPopt value on the TBI patients' outcome.

Methods: The CPP and cerebrovascular autoregulation (CA) monitoring of 52 TBI patients was performed. Patient-specific CPPopt has been identified and the associations between the patients' outcome and complex influence of time of CPP declination from CPPopt value, age, and the duration of CA impairment episodes has been analyzed.

Results: The multiple correlation coefficient between the Glasgow outcome scale (GOS), duration of CA impairment events and percentage time, when 0<ΔCPPopt<10mmHg was r=-0.643 (P<0.001). The multiple correlation coefficients between GOS, age, and percentage time of ΔCPPopt when 0<ΔCPPopt<10mmHg was r=-0.587 (P<0.001).

Conclusion: The CPPopt-targeted patient-specific management might be useful for stabilizing CA in TBI patients as well as for improving their outcome. Better outcomes were obtained by maintaining CPP in light hyperperfusion condition (up to 10mmHg above CPPopt) when CPPopt is in the range of 60-80mmHg, and keeping CPP within the range of CPPopt +/-5mmHg when CPPopt is above 80mmHg.

Keywords: Cerebrovascular autoregulation; Cerebrovascular reactivity; Optimal cerebral perfusion pressure; Traumatic brain injury.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brain Injuries, Traumatic / complications
Brain Injuries, Traumatic / physiopathology
Brain Injuries, Traumatic / therapy*
Cerebrovascular Circulation / physiology*
Critical Care*
Female
Glasgow Outcome Scale
Homeostasis
Humans
Intracranial Hypertension / physiopathology
Intracranial Hypertension / prevention & control
Intracranial Pressure / physiology*
Male
Prospective Studies
Young Adult