title: Adherence to guidelines for management of cerebral perfusion pressure and outcome in patients who have severe traumatic brain injury.
abstract: OBJECTIVE
  The aims of this study are to assess adherence to the Brain Trauma Foundation (BTF) cerebral perfusion pressure (CPP) guidelines and to determine if adherence is associated with mortality in patients who have a severe traumatic brain injury.
  
  
  METHODS
  Retrospective cohort study of 127 patients admitted to one intensive care unit between 2006 and 2012. Adherence to BTF guidelines was measured as the time that the CPP was within 50 to 70 mm Hg divided by the total time of CPP monitoring (CPP time index).
  
  
  RESULTS
  The percentage of time that the CPP was within the recommended range was 31.6% (SD, 22.2); CPP was greater than 70 mm Hg for 63.9% (SD, 26.2) of the time and less than 50 mm Hg for 4.5% of the time (SD, 16.3). After adjustment for covariates, CPP time index (between 50 and 70 mm Hg) was not associated with hospital mortality (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.98-1.6; P= .079). The time indices for CPP ≥70 and <50 mm Hg were associated with decreased (OR, 0.66; 95%CI, 0.52-0.82; P< .0001) and increased (OR, 9.9; 95% CI, 1.4-69.6; P= .021) mortality, respectively.
  
  
  CONCLUSIONS
  Cerebral perfusion pressure was greater than 70 mm Hg for most of the time. This level of CPP was associated with decreased hospital mortality.
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology and Therapeutics University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver British Columbia, Canada. Electronic address: donald.griesdale@vch.ca.
authors.forename: Donald E G
authors.initials: DE
authors.lastname: Griesdale
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Lund University, Lund, Sweden.
authors.forename: Victoria
authors.initials: V
authors.lastname: Örtenwall
authors.affiliation: Centre for Health Evaluation & Outcome Sciences, Providence Health Care and University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Norena
authors.affiliation: Centre for Health Evaluation & Outcome Sciences, Providence Health Care and University of British Columbia, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mypinder S
authors.initials: MS
authors.lastname: Sekhon
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Leif
authors.initials: L
authors.lastname: Kolmodin
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: William R
authors.initials: WR
authors.lastname: Henderson
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care and University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology*; D001955:British Columbia; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017410:Practice Guidelines as Topic; D012015:Reference Standards; D012189:Retrospective Studies
keywords: Area under curve; Brain injuries; Cerebral perfusion pressure; Intracranial pressure; Neurocritical care; Traumatic