A1 Refereed original research article in a scientific journal

The lower limit of reactivity as a potential individualised cerebral perfusion pressure target in traumatic brain injury: a CENTER-TBI high-resolution sub-study analysis




AuthorsBeqiri E., Zeiler F.A., Ercole A., Placek M.M., Tas J., Donnelly J., Aries M.J.H., Hutchinson P.J., Menon D., Stocchetti N., Czosnyka M., Smielewski P.; CENTER-TBI HR ICU participants and investigators

PublisherBioMed Central Ltd

Publication year2023

JournalCritical Care

Journal name in sourceCritical Care

Article number194

Volume27

Issue1

ISSN1466609X 13648535

DOIhttps://doi.org/10.1186/s13054-023-04485-8(external)

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/detail/Publication/179830438(external)


Abstract

Background: 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. We aim to validate this in a large multicentre cohort.

Methods: Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. 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. 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. AUCs (CI 95%) were calculated and compared using DeLong's test.

Results: Average LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP.

Conclusions: Using a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.


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Last updated on 2025-31-01 at 11:30