![]() The autoregulatory mechanism refers to the response of the cerebral circulation to changes in CPP. How to best individualise CPP targets in TBI patients admitted in intensive care unit (ICU) remains an open question.Ĭontinuous monitoring of cerebral autoregulation (CA) could provide a way to tailor CPP targets, as proposed and pioneered by our research group. Ensuring adequate cerebral perfusion pressure (CPP) is pivotal in supplying blood flow to the injured brain. The critical care management of traumatic brain injury (TBI) patients aims to reduce the occurrence and the burden of secondary insults, such as those caused by intracranial hypertension. Using a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury. ![]() ![]() The relationship was maintained when correcting for IMPACT covariates or for high ICP. This association becomes significant starting from the third day post injury. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). ResultsĪverage LLR over the first 7 days was above 60 mmHg in 48% of patients. AUCs (CI 95%) were calculated and compared using DeLong’s test. 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. 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. Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We aim to validate this in a large multicentre cohort. 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.
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