Vytautas Petkus1, Aidanas Preiksaitis2, Solventa Krakauskaite3, Erika Zubaviciute4, Saulius Rocka5, Daiva Rastenyte6, Saulius Vosylius5, Arminas Ragauskas1. 1. Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania. 2. Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania; Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Lithuania; Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania. 3. Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania. Electronic address: solventa@mail.com. 4. Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 5. Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania. 6. Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Lithuania.
Abstract
PURPOSE: The maintenance of patient-specific optimal cerebral perfusion pressure (CPPopt) is crucial for patients with traumatic brain injury (TBI). The goal of the study was to explore the influence of CPP declination from CPPopt value on the TBI patients' outcome. METHODS: The CPP and cerebrovascular autoregulation (CA) monitoring of 52 TBI patients was performed. Patient-specific CPPopt has been identified and the associations between the patients' outcome and complex influence of time of CPP declination from CPPopt value, age, and the duration of CA impairment episodes has been analyzed. RESULTS: The multiple correlation coefficient between the Glasgow outcome scale (GOS), duration of CA impairment events and percentage time, when 0<ΔCPPopt<10mmHg was r=-0.643 (P<0.001). The multiple correlation coefficients between GOS, age, and percentage time of ΔCPPopt when 0<ΔCPPopt<10mmHg was r=-0.587 (P<0.001). CONCLUSION: The CPPopt-targeted patient-specific management might be useful for stabilizing CA in TBI patients as well as for improving their outcome. Better outcomes were obtained by maintaining CPP in light hyperperfusion condition (up to 10mmHg above CPPopt) when CPPopt is in the range of 60-80mmHg, and keeping CPP within the range of CPPopt +/-5mmHg when CPPopt is above 80mmHg.
PURPOSE: The maintenance of patient-specific optimal cerebral perfusion pressure (CPPopt) is crucial for patients with traumatic brain injury (TBI). The goal of the study was to explore the influence of CPP declination from CPPopt value on the TBIpatients' outcome. METHODS: The CPP and cerebrovascular autoregulation (CA) monitoring of 52 TBIpatients was performed. Patient-specific CPPopt has been identified and the associations between the patients' outcome and complex influence of time of CPP declination from CPPopt value, age, and the duration of CA impairment episodes has been analyzed. RESULTS: The multiple correlation coefficient between the Glasgow outcome scale (GOS), duration of CA impairment events and percentage time, when 0<ΔCPPopt<10mmHg was r=-0.643 (P<0.001). The multiple correlation coefficients between GOS, age, and percentage time of ΔCPPopt when 0<ΔCPPopt<10mmHg was r=-0.587 (P<0.001). CONCLUSION: The CPPopt-targeted patient-specific management might be useful for stabilizing CA in TBIpatients as well as for improving their outcome. Better outcomes were obtained by maintaining CPP in light hyperperfusion condition (up to 10mmHg above CPPopt) when CPPopt is in the range of 60-80mmHg, and keeping CPP within the range of CPPopt +/-5mmHg when CPPopt is above 80mmHg.
Authors: Brian Appavu; Stephen Foldes; Brian T Burrows; Austin Jacobson; Todd Abruzzo; Varina Boerwinkle; Anthony Willyerd; Tara Mangum; Vishal Gunnala; Iris Marku; P D Adelson Journal: Neurocrit Care Date: 2020-08-04 Impact factor: 3.210