Time spent above optimal cerebral perfusion pressure is not associated with failure to improve in outcome in traumatic brain injury

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dc.contributor.authorStein, Kevin
dc.contributor.authorFroese, Logan
dc.contributor.authorGomez, Alwyn
dc.contributor.authorSainbhi, Amanjyot S.
dc.contributor.authorVakitbilir, Nuray
dc.contributor.authorIbrahim, Younis
dc.contributor.authorIslam, Abrar
dc.contributor.authorMarquez, Izabella
dc.contributor.authorAmenta, Fiorella
dc.contributor.authorBergmann, Tobias
dc.contributor.authorZeiler, Frederick
dc.date.accessioned2024-01-03T22:41:00Z
dc.date.available2024-01-03T22:41:00Z
dc.date.issued2023-12-14
dc.date.updated2024-01-01T08:11:12Z
dc.description.abstractBackground Optimal cerebral perfusion pressure (CPPopt) has emerged as a promising personalized medicine approach to the management of moderate-to-severe traumatic brain injury (TBI). Though literature demonstrating its association with poor outcomes exists, there is yet to be work done on its association with outcome transition due to a lack of serial outcome data analysis. In this study we investigate the association between various metrics of CPPopt and failure to improve in outcome over time. Methods CPPopt was derived using three different cerebrovascular reactivity indices; the pressure reactivity index (PRx), the pulse amplitude index (PAx), and the RAC index. For each index, % times spent with cerebral perfusion pressure (CPP) above and below its CPPopt and upper and lower limits of reactivity were calculated. Patients were dichotomized based on improvement in Glasgow Outcome Scale-Extended (GOSE) scores into Improved vs. Not Improved between 1 and 3 months, 3 and 6 months, and 1- and 6-month post-TBI. Logistic regression analyses were then conducted, adjusting for the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) variables. Results This study included a total of 103 patients from the Winnipeg Acute TBI Database. Through Mann–Whitney U testing and logistic regression analysis, it was found that % time spent with CPP below CPPopt was associated with failure to improve in outcome, while % time spent with CPP above CPPopt was generally associated with improvement in outcome. Conclusions Our study supports the existing narrative that time spent with CPP below CPPopt results in poorer outcomes. However, it also suggests that time spent above CPPopt may not be associated with worse outcomes and is possibly even associated with improvement in outcome.
dc.identifier.citationIntensive Care Medicine Experimental. 2023 Dec 14;11(1):92
dc.identifier.doi10.1186/s40635-023-00579-3
dc.identifier.urihttp://hdl.handle.net/1993/37907
dc.language.isoeng
dc.language.rfc3066en
dc.publisherSpringerOpen
dc.rightsopen accessen_US
dc.rights.holderThe Author(s)
dc.subjectOptimal cerebral perfusion pressure
dc.subjectOutcome transition
dc.subjectTraumatic brain injury
dc.subjectPrediction
dc.subjectTreatment failure
dc.titleTime spent above optimal cerebral perfusion pressure is not associated with failure to improve in outcome in traumatic brain injury
dc.typeJournal Article
local.author.affiliationPrice Faculty of Engineering::Department of Biosystems Engineering
oaire.citation.titleIntensive Care Medicine Experimental
oaire.citation.volume11
project.funder.identifierhttps://doi.org/10.13039/501100000038
project.funder.nameNatural Sciences and Engineering Research Council of Canada
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