Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: a CENTER-TBI study
Creators: name: Riemann, Lennart
name: Beqiri, Erta
name: Smielewski, Peter
name: Czosnyka, Marek
name: Stocchetti, Nino
name: Sakowitz, Oliver
name: Zweckberger, Klaus
name: Unterberg, Andreas
name: Younsi, Alexander
name: Anke, Audny
name: Beer, Ronny
name: Bellander, Bo-Michael
name: Buki, Andras
name: Chevallard, Giorgio
name: Chieregato, Arturo
name: Citerio, Giuseppe
name: Czeiter, Endre
name: Depreitere, Bart
name: Eapen, George
name: Frisvold, Shirin
name: Helbok, Raimund
name: Jankowski, Stefan
name: Kondziella, Daniel
name: Koskinen, Lars-Owe
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: Stevanovic, Ana
name: Sundström, Nina
name: Takala, Riikka
name: Tamosuitis, Tomas
name: Tenovuo, Olli
name: Vajkoczy, Peter
name: Vargiolu, Alessia
name: Vilcinis, Rimantas
name: Wolf, Stefan
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Research
Cerebral autoregulation
Cerebrovascular reactivity
Cerebral perfusion pressure
CPPopt
Traumatic brain injury

description: Abstract: Background: After traumatic brain injury (TBI), brain tissue can be further damaged when cerebral autoregulation is impaired. Managing cerebral perfusion pressure (CPP) according to computed “optimal CPP” values based on cerebrovascular reactivity indices might contribute to preventing such secondary injuries. In this study, we examined the discriminative value of a low-resolution long pressure reactivity index (LPRx) and its derived “optimal CPP” in comparison to the well-established high-resolution pressure reactivity index (PRx). Methods: Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study dataset, the association of LPRx (correlation between 1-min averages of intracranial pressure and arterial blood pressure over a moving time frame of 20 min) and PRx (correlation between 10-s averages of intracranial pressure and arterial blood pressure over a moving time frame of 5 min) to outcome was assessed and compared using univariate and multivariate regression analysis. “Optimal CPP” values were calculated using a multi-window algorithm that was based on either LPRx or PRx, and their discriminative ability was compared. Results: LPRx and PRx were both significant predictors of mortality in univariate and multivariate regression analysis, but PRx displayed a higher discriminative ability. Similarly, deviations of actual CPP from “optimal CPP” values calculated from each index were significantly associated with outcome in univariate and multivariate analysis. “Optimal CPP” based on PRx, however, trended towards more precise predictions. Conclusions: LPRx and its derived “optimal CPP” which are based on low-resolution data were significantly associated with outcome after TBI. However, they did not reach the discriminative ability of the high-resolution PRx and its derived “optimal CPP.” Nevertheless, LPRx might still be an interesting tool to assess cerebrovascular reactivity in centers without high-resolution signal monitoring. Trial registration: ClinicalTrials.gov Identifier: NCT02210221. First submitted July 29, 2014. First posted August 6, 2014.