Abstract
Background: The concept of CPPopt, a variable cerebral perfusion pressure (CPP) target based on cerebrovascular autoregulatory capacity in severe traumatic brain injury (TBI), is promising. CPPopt calculation is based on the continuous plotting of the pressure reactivity Index (PRx) against CPP and requires processing of waveform quality data. The aim of this study is to investigate whether CPPopt can also be calculated based on minute-by-minute data. Methods: A low-resolution autoregulation index (LAx) was defined as the minute-by-minute intracranial pressure–mean arterial pressure correlation over varying time intervals. A matrix of LAx-CPP plots was built using different LAx values and varying time windows. CPPopt was calculated as the weighted average of the CPPopt values resulting from each plot. The method was assessed in a database of 21 patients with TBI with 60-Hz data. Results: No significant difference was observed between PRx-based and LAx-based CPPopt values. The new method was able to issue a CPPopt recommendation throughout almost the entire monitoring time. The absolute difference between CPP and CPPopt was inversely associated with survival. Conclusion: CPPopt calculation based on standard resolution data compared well with PRx-based CPPopt and may represent a promising alternative method, avoiding the need for waveform quality data capture. Further validation of this new method is required.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Aries MJ, Czosnyka M, Budohoski KP, Steiner LA, Lavinio A, Kolias AG et al (2012) Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med 40:2456–2463
Bullock MR, Povlishock JT (2007) Guidelines for the management of severe traumatic brain injury, 3rd edition. J Neurotrauma 24(Suppl 1):S1–S106
Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD (1997) Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery 41:11–19
Depreitere B, Güiza F, Van den Berghe G, Schuhmann M, Maier G, Piper I, Meyfroidt G (2014) Pressure autoregulation monitoring and cerebral perfusion pressure target recommendation in severe traumatic brain injury patients based on minute-by-minute monitoring data. J Neurosurg 120:1451–1457 [JNS13-1500R1]
Guiza F, Depreitere B, Piper I, Van den Berghe G, Meyfroidt G (2013) Novel methods to predict increased intracranial pressure during intensive care and long-term neurologic outcome after traumatic brain injury: development and validation in a multicenter dataset. Crit Care Med 41:554–564
Howells T, Elf K, Jones PA, Ronne-Engström E, Piper I, Nilsson P et al (2005) Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg 102:311–317
Juul N, Morris GF, Marshall SB, Marshall LF (2000) Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg 92:1–6
Robertson CS, Valadka AB, Hannay HJ, Contant CF, Gopinath SP, Cormio M et al (1999) Prevention of secondary ischemic insults after severe head injury. Crit Care Med 27:2086–2095
Santos E, Diedler J, Sykora M, Orakcioglu B, Kentar M, Czosnyka M et al (2011) Low-frequency sampling for PRx calculation does not reduce prognostication and produces similar CPPopt in intracerebral haemorrhage patients. Acta Neurochir (Wien) 153:2189–2195
Steiner LA, Czosnyka M, Piechnik K, Smielewski P, Chatfield D, Menon DK et al (2002) Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med 30:733–738
Sviri GE, Aaslid R, Douville CM, Moore A, Newell DE (2009) Time course for autoregulation recovery following severe traumatic brain injury. J Neurosurg 111:695–700
Zweifel C, Lavinio A, Steiner L, Radolovich D, Smielewski P, Timofeev I et al (2008) Continuous monitoring of cerebrovascular pressure reactivity in patients with head injury. Neurosurg Focus 25, E2
Conflict of Interest Statement
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Depreitere, B. et al. (2016). Can Optimal Cerebral Perfusion Pressure in Patients with Severe Traumatic Brain Injury Be Calculated Based on Minute-by-Minute Data Monitoring?. In: Ang, BT. (eds) Intracranial Pressure and Brain Monitoring XV. Acta Neurochirurgica Supplement, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-22533-3_49
Download citation
DOI: https://doi.org/10.1007/978-3-319-22533-3_49
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-22532-6
Online ISBN: 978-3-319-22533-3
eBook Packages: MedicineMedicine (R0)