Descriptive analysis of low versus elevated intracranial pressure on cerebral physiology in adult traumatic brain injury: a CENTER-TBI exploratory study
Creators: name: Zeiler, Frederick A.
name: Ercole, Ari
name: Cabeleira, Manuel
name: Stocchetti, Nino
name: Hutchinson, Peter J.
name: Smielewski, Peter
name: Czosnyka, Marek
name: Anke, Audny
name: Beer, Ronny
name: Bellander, Bo-Michael
name: Beqiri, Erta
name: Buki, Andras
name: Carbonara, Marco
name: Chieregato, Arturo
name: Citerio, Giuseppe
name: Clusmann, Hans
name: Czeiter, Endre
name: Depreitere, Bart
name: Frisvold, Shirin
name: Helbok, Raimund
name: Jankowski, Stefan
name: Kondziella, Daniel
name: Koskinen, Lars-Owe
name: Kowark, Ana
name: Menon, David K.
name: Meyfroidt, Geert
name: Moeller, Kirsten
name: Nelson, David
name: Piippo-Karjalainen, Anna
name: Radoi, Andreea
name: Ragauskas, Arminas
name: Raj, Rahul
name: Rhodes, Jonathan
name: Rocka, Saulius
name: Rossaint, Rolf
name: Sahuquillo, Juan
name: Sakowitz, Oliver
name: Sundström, Nina
name: Takala, Riikka
name: Tamosuitis, Tomas
name: Tenovuo, Olli
name: Unterberg, Andreas
name: Vajkoczy, Peter
name: Vargiolu, Alessia
name: Vilcinis, Rimantas
name: Wolf, Stefan
name: Younsi, Alexander
name: Zeiler, Frederick A.
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Original Article - Brain trauma
Brain trauma
Cerebral physiology
Cerebrovascular reactivity
ICP extremes
Outcomes

description: Funder: University of Cambridge
description: Abstract: Background: To date, the cerebral physiologic consequences of persistently elevated intracranial pressure (ICP) have been based on either low-resolution physiologic data or retrospective high-frequency data from single centers. The goal of this study was to provide a descriptive multi-center analysis of the cerebral physiologic consequences of ICP, comparing those with normal ICP to those with elevated ICP. Methods: The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) High-Resolution Intensive Care Unit (HR-ICU) sub-study cohort was utilized. The first 3 days of physiologic recording were analyzed, evaluating and comparing those patients with mean ICP &lt; 15 mmHg versus those with mean ICP &gt; 20 mmHg. Various cerebral physiologic parameters were derived and evaluated, including ICP, brain tissue oxygen (PbtO2), cerebral perfusion pressure (CPP), pulse amplitude of ICP (AMP), cerebrovascular reactivity, and cerebral compensatory reserve. The percentage time and dose above/below thresholds were also assessed. Basic descriptive statistics were employed in comparing the two cohorts. Results: 185 patients were included, with 157 displaying a mean ICP below 15 mmHg and 28 having a mean ICP above 20 mmHg. For admission demographics, only admission Marshall and Rotterdam CT scores were statistically different between groups (p = 0.017 and p = 0.030, respectively). The high ICP group displayed statistically worse CPP, PbtO2, cerebrovascular reactivity, and compensatory reserve. The high ICP group displayed worse 6-month mortality (p &lt; 0.0001) and poor outcome (p = 0.014), based on the Extended Glasgow Outcome Score. Conclusions: Low versus high ICP during the first 72 h after moderate/severe TBI is associated with significant disparities in CPP, AMP, cerebrovascular reactivity, cerebral compensatory reserve, and brain tissue oxygenation metrics. Such ICP extremes appear to be strongly related to 6-month patient outcomes, in keeping with previous literature. This work provides multi-center validation for previously described single-center retrospective results.