Summary
Cerebral perfusion pressure (CPP) lower limits of reactivity can be determined almost continuously after severe traumatic brain injury (TBI), and deviation below the lower limit carries important prognostic information. In this study, we used a recently derived coloured contour method for visualizing intracranial pressure (ICP) insults to describe the influence of having a CPP above the CPP lower limits of reactivity after severe TBI. In a cohort of 729 patients, we examined the relationship between ICP insults and the 6-month Glasgow Outcome Scale score, using colour-coded plots, as described previously. We then assessed this relationship when ICP insults were above or below the CPP lower limit of reactivity. We found a curvilinear relationship whereby even prolonged durations of low-intensity ICP insults were not associated with poor outcomes but short durations of high-intensity insults were. When only ICP insults with a CPP below the CPP lower limit of reactivity were considered, a much lower intensity of ICP insults could be tolerated. A CPP above the lower limits of reactivity exerts a protective effect, whereas a CPP below the lower reactivity limits renders the patient vulnerable to increased morbidity from intracranial hypertension.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Donnelly J, Czosnyka M, Harland S, Varsos GV, Cardim D, Robba C, Liu X, Ainslie PN, Smielewski P (2017) Cerebral haemodynamics during experimental intracranial hypertension. J Cereb Blood Flow Metab 37(2):694–705
Donnelly J, Smielewski P, Adams H, Zeiler FA, Cardim D, Liu X, Fedriga M, Hutchinson P, Menon DK, Czosnyka M (2019) Observations on the cerebral effects of refractory intracranial hypertension after severe traumatic brain injury. Neurocrit Care 32:437–447. https://doi.org/10.1007/s12028-019-00748-x
Güiza F, Depreitere B, Piper I et al (2015) Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury. Intensive Care Med 41(6):1067–1076. https://doi.org/10.1007/s00134-015-3806-1
Donnelly J, Budohoski KP, Smielewski P, Czosnyka M (2016) Regulation of the cerebral circulation: bedside assessment and clinical implications. Crit Care 20(1):129
Donnelly J, Czosnyka M, Adams H et al (2017) Individualising thresholds of cerebral perfusion pressure using estimated limits of autoregulation. Crit Care Med 45(9):1464
Aries MJH, Czosnyka M, Budohoski KP et al (2012) Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med 40(8):2456–2463
Liu X, Maurits NM, Aries MJH et al (2017) Monitoring of optimal cerebral perfusion pressure in traumatic brain injured patients using a multi-window weighting algorithm. J Neurotrauma 34(22):3081–3088
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Ethics declarations
ICM+® software is licensed by Cambridge Enterprise Ltd. (Cambridge, UK) (https://icmplus.neurosurg.cam.ac.uk). Marek Czosnyka and Peter Smielewski have a financial interest in a fraction of the licensing fee.
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Donnelly, J. et al. (2021). Visualization of Intracranial Pressure Insults After Severe Traumatic Brain Injury: Influence of Individualized Limits of Reactivity. In: Depreitere, B., Meyfroidt, G., Güiza, F. (eds) Intracranial Pressure and Neuromonitoring XVII. Acta Neurochirurgica Supplement, vol 131. Springer, Cham. https://doi.org/10.1007/978-3-030-59436-7_2
Download citation
DOI: https://doi.org/10.1007/978-3-030-59436-7_2
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-59435-0
Online ISBN: 978-3-030-59436-7
eBook Packages: MedicineMedicine (R0)