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A National Trial on Differences in Cerebral Perfusion Pressure Values by Measurement Location

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Abstract

Background

Cerebral perfusion pressure (CPP) is a key parameter in management of brain injury with suspected impaired cerebral autoregulation. CPP is calculated by subtracting intracranial pressure (ICP) from mean arterial pressure (MAP). Despite consensus on importance of CPP monitoring, substantial variations exist on anatomical reference points used to measure arterial MAP when calculating CPP. This study aimed to identify differences in CPP values based on measurement location when using phlebostatic axis (PA) or tragus (Tg) as anatomical reference points. The secondary study aim was to determine impact of differences on patient outcomes at discharge.

Methods

This was a prospective, repeated measures, multi-site national trial. Adult ICU patients with neurological injury necessitating ICP and CPP monitoring were consecutively enrolled from seven sites. Daily MAP/ICP/CPP values were gathered with the arterial transducer at the PA, followed by the Tg as anatomical reference points.

Results

A total of 136 subjects were enrolled, resulting in 324 paired observations. There were significant differences for CPP when comparing values obtained at PA and Tg reference points (p < 0.000). Differences remained significant in repeated measures model when controlling for clinical factors (mean CPP-PA = 80.77, mean CPP-Tg = 70.61, p < 0.000). When categorizing CPP as binary endpoint, 18.8% of values were identified as adequate with PA values, yet inadequate with CPP values measured at the Tg.

Conclusion

Findings identify numerical differences for CPP based on anatomical reference location and highlight importance of a standard reference point for both clinical practice and future trials to limit practice variations and heterogeneity of findings.

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Funding

This study was funded by a research grant from the Agnes Marshall Walker Foundation.

Author information

Authors and Affiliations

  1. Department of Nursing Research, The MetroHealth System, Cleveland, OH, USA

    Molly M. McNett & Cristina Moran

  2. Neurocritical Care, Mission Hospital, Mission Viejo, CA, USA

    Mary Kay Bader

  3. Rush University College of Nursing, Chicago, IL, USA

    Sarah Livesay

  4. Neurocritical Care, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Susan Yeager

  5. Surgical ICU, Mission Hospital, Mission Viejo, CA, USA

    Arianna Barnes

  6. Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA

    Kimberly R. Harrison & DaiWai M. Olson

Authors
  1. Molly M. McNett
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  2. Mary Kay Bader
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  3. Sarah Livesay
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  4. Susan Yeager
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  5. Cristina Moran
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  6. Arianna Barnes
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  7. Kimberly R. Harrison
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  8. DaiWai M. Olson
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Corresponding author

Correspondence to Molly M. McNett.

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Conflict of interest

The following author disclosures include: Dr. McNett has research funding from the Agnes Marshall Walker Foundation and is on the Editorial Board for the Neurocritical Care Journal. Mary Kay Bader has stock options for Cerebrotech and Neuroptics, serves on the Medical Advisory board for the Brain Trauma Foundation, is a member of the Board of Directors and serves as Secretary for the Neurocritical Care Society, and receives honorariums from Bard Medical. Dr. Livesay is a consultant and receives honorariums for Stryker and is a stroke program consultant. Dr. Olson has received research funding from the Agnes Marshall Walker Foundation and the Integra Foundation. He is also the Editor-in-Chief of The Journal of Neuroscience Nursing.

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McNett, M.M., Bader, M.K., Livesay, S. et al. A National Trial on Differences in Cerebral Perfusion Pressure Values by Measurement Location. Neurocrit Care 28, 221–228 (2018). https://doi.org/10.1007/s12028-017-0467-7

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  • DOI: https://doi.org/10.1007/s12028-017-0467-7

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