The lower limit of reactivity as a potential individualised cerebral perfusion pressure target in traumatic brain injury: a CENTER-TBI high-resolution sub-study analysis.
Cerebral autoregulation
Individualised cerebral perfusion pressure
Lower limit of reactivity
Traumatic brain injury
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
20 05 2023
20 05 2023
Historique:
received:
23
01
2023
accepted:
11
05
2023
medline:
22
5
2023
pubmed:
21
5
2023
entrez:
20
5
2023
Statut:
epublish
Résumé
A previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort. Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal-Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong's test. Average LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP. Using a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.
Sections du résumé
BACKGROUND
A previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort.
METHODS
Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal-Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong's test.
RESULTS
Average LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP.
CONCLUSIONS
Using a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.
Identifiants
pubmed: 37210526
doi: 10.1186/s13054-023-04485-8
pii: 10.1186/s13054-023-04485-8
pmc: PMC10199598
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
194Subventions
Organisme : Medical Research Council
ID : MR N013433-1
Pays : United Kingdom
Investigateurs
Audny Anke
(A)
Ronny Beer
(R)
Bo-Michael Bellander
(BM)
Andras Buki
(A)
Manuel Cabeleira
(M)
Marco Carbonara
(M)
Arturo Chieregato
(A)
Giuseppe Citerio
(G)
Hans Clusmann
(H)
Endre Czeiter
(E)
Bart Depreitere
(B)
Shirin Frisvold
(S)
Raimund Helbok
(R)
Stefan Jankowski
(S)
Daniel Kondziella
(D)
Lars-Owe Koskinen
(LO)
Ana Kowark
(A)
Geert Meyfroidt
(G)
Kirsten Moeller
(K)
David Nelson
(D)
Anna Piippo-Karjalainen
(A)
Andreea Radoi
(A)
Arminas Ragauskas
(A)
Rahul Raj
(R)
Jonathan Rhodes
(J)
Saulius Rocka
(S)
Rolf Rossaint
(R)
Juan Sahuquillo
(J)
Oliver Sakowitz
(O)
Nina Sundström
(N)
Riikka Takala
(R)
Tomas Tamosuitis
(T)
Olli Tenovuo
(O)
Andreas Unterberg
(A)
Peter Vajkoczy
(P)
Alessia Vargiolu
(A)
Rimantas Vilcinis
(R)
Stefan Wolf
(S)
Alexander Younsi
(A)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023. The Author(s).
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