title: Cerebral Perfusion Pressure Insults and Associations with Outcome in Adult Traumatic Brain Injury.
abstract: The definition of cerebral perfusion pressure (CPP) secondary insults in severe traumatic brain injury remains unclear. The purpose of the present study is to visualize the association of intensity and duration of episodes below or above CPP thresholds and outcome. The analysis was based on prospectively collected minute-by-minute intracranial pressure (ICP) and blood pressure data and outcome from 259 adult patients. The relationship of episodes of CPP below or above a certain threshold for certain duration with the 6-month Glasgow Outcome Score was visualized separately for episodes of active or deficient autoregulation (AR). In adults ≤65 years, an almost exponential transition curve separates the episodes of CPP associated with better outcomes from the episodes of low CPP associated with worse outcomes, indicating that lower CPP could only be tolerated for a brief time. Analysis of episodes of high CPP again showed a time-intensity dependent association with outcome. When combining the two plots, a safe CPP zone between 60 and 70 mm Hg could be delineated-however, only for AR active insults. The AR status predominantly affected the transition curve for insults of low CPP. Episodes with ICP >25 mm Hg were associated with poor outcome regardless of CPP. In the present study, the CPP pressure-time burden associated with poor outcome was visualized. A safe zone between 60 and 70 mm Hg could be identified for adults ≤65 years, provided AR was active and ICP was ≤25 mm Hg. Deficient AR reduces the tolerability for low CPP.
authors.affiliation: 1 Department of Intensive Care Medicine, University Hospitals Leuven , Leuven, Belgium .
authors.forename: Fabian
authors.initials: F
authors.lastname: Güiza
authors.affiliation: 1 Department of Intensive Care Medicine, University Hospitals Leuven , Leuven, Belgium .
authors.forename: Geert
authors.initials: G
authors.lastname: Meyfroidt
authors.affiliation: 2 Department of Clinical Physics, Southern General Hospital , Glasgow, United Kingdom .
authors.forename: Ian
authors.initials: I
authors.lastname: Piper
authors.affiliation: 3 Department of Perioperative Medicine and Intensive Care Medicine, San Gerardo Hospital , Monza, Italy .
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
authors.affiliation: 4 Medical Physics, James Cook University Hospital , Middlesborough, United Kingdom .
authors.forename: Iain
authors.initials: I
authors.lastname: Chambers
authors.affiliation: 5 Department of Neurosciences, Neurosurgery , Uppsala, Sweden .
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
authors.affiliation: 5 Department of Neurosciences, Neurosurgery , Uppsala, Sweden .
authors.forename: Pelle
authors.initials: P
authors.lastname: Nillson
authors.affiliation: 6 Department of Neurosurgery, Antwerp University Hospital , Edegem, Belgium .
authors.forename: Bart
authors.initials: B
authors.lastname: Feyen
authors.affiliation: 7 Department of Intensive Care Medicine, Antwerp University Hospital , Edegem, Belgium .
authors.forename: Philippe
authors.initials: P
authors.lastname: Jorens
authors.affiliation: 6 Department of Neurosurgery, Antwerp University Hospital , Edegem, Belgium .
authors.forename: Andrew
authors.initials: A
authors.lastname: Maas
authors.affiliation: 8 Klinik für Neurochirurgie, Universitätsklinikum Tübingen , Tübingen, Germany .
authors.forename: Martin U
authors.initials: MU
authors.lastname: Schuhmann
authors.affiliation: 9 School of Mathematics and Statistics, University of Glasgow , Glasgow, United Kingdom .
authors.forename: Rob
authors.initials: R
authors.lastname: Donald
authors.affiliation: 10 Department of Clinical Physics and Bioengineering, NHS Greater Glasgow & Clyde , Glasgow, United Kingdom .
authors.forename: Laura
authors.initials: L
authors.lastname: Moss
authors.affiliation: 1 Department of Intensive Care Medicine, University Hospitals Leuven , Leuven, Belgium .
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
authors.affiliation: 11 Department of Neurosurgery, University Hospitals Leuven , Leuven, Belgium .
authors.forename: Bart
authors.initials: B
authors.lastname: Depreitere
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology* / Q000601:surgery; D002560:Cerebrovascular Circulation; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D055815:Young Adult
keywords: adults; cerebral perfusion pressure; cerebrovascular autoregulation; traumatic brain injury