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.
Giza, F., Meyfroidt, G., Piper, I., Citerio, G., Chambers, I., Enblad, P., et al. (2017). Cerebral Perfusion Pressure Insults and Associations with Outcome in Adult Traumatic Brain Injury. JOURNAL OF NEUROTRAUMA, 34(16), 2425-2431.
|Citazione:||Giza, F., Meyfroidt, G., Piper, I., Citerio, G., Chambers, I., Enblad, P., et al. (2017). Cerebral Perfusion Pressure Insults and Associations with Outcome in Adult Traumatic Brain Injury. JOURNAL OF NEUROTRAUMA, 34(16), 2425-2431.|
|Tipo:||Articolo in rivista - Articolo scientifico|
|Carattere della pubblicazione:||Scientifica|
|Presenza di un coautore afferente ad Istituzioni straniere:||Si|
|Titolo:||Cerebral Perfusion Pressure Insults and Associations with Outcome in Adult Traumatic Brain Injury|
|Autori:||Giza, F; Meyfroidt, G; Piper, I; Citerio, G; Chambers, I; Enblad, P; Nilsson, P; Feyen, B; Jorens, P; Maas, A; Schuhmann, M; Donald, R; Moss, L; Van den Berghe, G; Depreitere, B|
|Data di pubblicazione:||2017|
|Rivista:||JOURNAL OF NEUROTRAUMA|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1089/neu.2016.4807|
|Appare nelle tipologie:||01 - Articolo su rivista|