Effect of continuous display of cerebral perfusion pressure on outcomes in patients with traumatic brain injury.
BACKGROUND
Clinical bedside monitoring systems do not provide prominent displays of data on cerebral perfusion pressure (CPP). Immediate visual feedback would allow more rapid intervention to prevent or minimize suboptimal pressures.


OBJECTIVE
To evaluate the effect of a highly visible CPP display on immediate and long-term functional outcome in patients with traumatic brain injury.


METHODS
A total of 157 patients with traumatic brain injury at a level 1 trauma center who had invasive arterial blood pressure and intracranial pressure monitoring were randomized to beds with or without an additional, prominent continuous CPP display. Primary end points were scores on the Extended Glasgow Outcome Scale (GOSE) and Functional Status Examination (FSE) 6 months after injury. Secondary end points were GOSE scores at discharge and 3 months after injury and FSE score 3 months after injury.


RESULTS
Although GOSE and FSE scores at 6 months were better in the group with the highly visible CPP display, the differences were not significant. Slope of recovery for GOSE and FSE over all follow-up time points did not differ significantly between groups. However, the intervention's positive effect on odds of survival at hospital discharge was strong and significant. Within a subgroup of more severely injured patients, the intervention group was much less likely than the control group to have CPP deviations.


CONCLUSIONS
The presence of a highly visible display of CPP was associated with significantly better odds of survival and overall condition at discharge.
Kirkness
Catherine J
CJ
Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA 98195-7266, USA. kirkness@u.washington.edu
Burr
Robert L
RL
Cain
Kevin C
KC
Newell
David W
DW
Mitchell
Pamela H
PH
D000328:Adult; D001794:Blood Pressure; D001921:Brain / Q000098:blood supply*; D001930:Brain Injuries / Q000175:diagnosis* / Q000451:nursing; D003626:Data Display; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D019095:Point-of-Care Systems; D016019:Survival Analysis