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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

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 m...

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Main Authors: Beqiri, Erta (Author) , Zeiler, Frederick A. (Author) , Ercole, Ari (Author) , Placek, Michal M. (Author) , Tas, Jeanette (Author) , Donnelly, Joseph (Author) , Aries, Marcel J. H. (Author) , Hutchinson, Peter J. (Author) , Menon, David (Author) , Stocchetti, Nino (Author) , Czosnyka, Marek (Author) , Smielewski, Peter (Author) , Anke, Audny (Author) , Beer, Ronny (Author) , Bellander, Bo-Michael (Author) , Buki, Andras (Author) , Cabeleira, Manuel (Author) , Carbonara, Marco (Author) , Chieregato, Arturo (Author) , Citerio, Giuseppe (Author) , Clusmann, Hans (Author) , Czeiter, Endre (Author) , Depreitere, Bart (Author) , Frisvold, Shirin (Author) , Helbok, Raimund (Author) , Jankowski, Stefan (Author) , Kondziella, Daniel (Author) , Koskinen, Lars-Owe (Author) , Kowark, Ana (Author) , Meyfroidt, Geert (Author) , Moeller, Kirsten (Author) , Nelson, David (Author) , Piippo-Karjalainen, Anna (Author) , Radoi, Andreea (Author) , Ragauskas, Arminas (Author) , Raj, Rahul (Author) , Rhodes, Jonathan (Author) , Rocka, Saulius (Author) , Rossaint, Rolf (Author) , Sahuquillo, Juan (Author) , Sakowitz, Oliver (Author) , Sundström, Nina (Author) , Takala, Riikka (Author) , Tamosuitis, Tomas (Author) , Tenovuo, Olli (Author) , Unterberg, Andreas (Author) , Vajkoczy, Peter (Author) , Vargiolu, Alessia (Author) , Vilcinis, Rimantas (Author) , Wolf, Stefan (Author) , Younsi, Alexander (Author)
Format: Article (Journal)
Language:English
Published: 20 May 2023
In: Critical care
Year: 2023, Volume: 27, Pages: 1-14
ISSN:1466-609X
DOI:10.1186/s13054-023-04485-8
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1186/s13054-023-04485-8
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Author Notes:Erta Beqiri, Frederick A. Zeiler, Ari Ercole, Michal M. Placek, Jeanette Tas, Joseph Donnelly, Marcel J. H. Aries, Peter J. Hutchinson, David Menon, Nino Stocchetti, Marek Czosnyka, Peter Smielewski, CENTER-TBI HR ICU participants and investigators: Audny Anke, Ronny Beer, Bo-Michael Bellander, Andras Buki, Manuel Cabeleira, Marco Carbonara, Arturo Chieregato, Giuseppe Citerio, Hans Clusmann, Endre Czeiter, Bart Depreitere, Shirin Frisvold, Raimund Helbok, Stefan Jankowski, Daniel Kondziella, Lars-Owe Koskinen, Ana Kowark, Geert Meyfroidt, Kirsten Moeller, David Nelson, Anna Piippo-Karjalainen, Andreea Radoi, Arminas Ragauskas, Rahul Raj, Jonathan Rhodes, Saulius Rocka, Rolf Rossaint, Juan Sahuquillo, Oliver Sakowitz, Nina Sundström, Riikka Takala, Tomas Tamosuitis, Olli Tenovuo, Andreas Unterberg, Peter Vajkoczy, Alessia Vargiolu, Rimantas Vilcinis, Stefan Wolf, Alexander Younsi
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Summary: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.
Item Description:Gesehen am 17.07.2023
Physical Description:Online Resource
ISSN:1466-609X
DOI:10.1186/s13054-023-04485-8

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