Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis
Creators: name: Zeiler, Frederick A.
name: Ercole, Ari
name: Beqiri, Erta
name: Cabeleira, Manuel
name: Aries, Marcel
name: Zoerle, Tommaso
name: Carbonara, Marco
name: Stocchetti, Nino
name: Smielewski, Peter
name: Czosnyka, Marek
name: Menon, David K.
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: Sakowitz, Oliver
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
name: Younsi, Alexander
Publisher: name: Apollo - University of Cambridge Repository
Year: 2019
Subjects: Original Article - Brain trauma
Brain trauma
Cerebrovascular reactivity
PRx
TBI
Therapeutic intensity
TIL

description: Abstract: Background: Impaired cerebrovascular reactivity in adult traumatic brain injury (TBI) is known to be associated with poor outcome. However, there has yet to be an analysis of the association between the comprehensively assessed intracranial hypertension therapeutic intensity level (TIL) and cerebrovascular reactivity. Methods: Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived pressure reactivity index (PRx) as the moving correlation coefficient between slow-wave in ICP and mean arterial pressure, updated every minute. Mean daily PRx, and daily % time above PRx of 0 were calculated for the first 7 days of injury and ICU stay. This data was linked with the daily TIL-Intermediate scores, including total and individual treatment sub-scores. Daily mean PRx variable values were compared for each TIL treatment score via mean, standard deviation, and the Mann U test (Bonferroni correction for multiple comparisons). General fixed effects and mixed effects models for total TIL versus PRx were created to display the relation between TIL and cerebrovascular reactivity. Results: A total of 249 patients with 1230 ICU days of high frequency physiology matched with daily TIL, were assessed. Total TIL was unrelated to daily PRx. Most TIL sub-scores failed to display a significant relationship with the PRx variables. Mild hyperventilation (p &lt; 0.0001), mild hypothermia (p = 0.0001), high levels of sedation for ICP control (p = 0.0001), and use vasopressors for CPP management (p &lt; 0.0001) were found to be associated with only a modest decrease in mean daily PRx or % time with PRx above 0. Conclusions: Cerebrovascular reactivity remains relatively independent of intracranial hypertension therapeutic intensity, suggesting inadequacy of current TBI therapies in modulating impaired autoregulation. These findings support the need for investigation into the molecular mechanisms involved, or individualized physiologic targets (ICP, CPP, or Co2) in order to treat dysautoregulation actively.