Summary
Background: The ‘optimal’ CPP (CPPopt) concept is based on the vascular pressure reactivity index (PRx). The feasibility and effectiveness of CPPopt guided therapy in severe traumatic brain injury (TBI) patients is currently being investigated prospectively in the COGiTATE trial. At the moment there is no clear evidence that certain admission and treatment characteristics are associated with CPPopt availability (yield).
Objective: To test the relation between patients’ admission and treatment characteristics and the average CPPopt yield.
Methods: Retrospective analysis of 230 patients from the CENTER-TBI high-resolution database with intracranial pressure (ICP) measured using an intraparenchymal probe. CPPopt was calculated using the algorithm set for the COGiTATE study. CPPopt yield was defined as the percentage of CPP monitored time (%) when CPPopt is available. The variables in the statistical model included age, admission Glasgow Coma Scale (GCS), gender, pupil response, hypoxia and hypotension at the scene, Marshall computed tomography (CT) score, decompressive craniectomy, injury severity score score and 24-h therapeutic intensity level (TIL) score.
Results: The median CPPopt yield was 80.7% (interquartile range 70.9–87.4%). None of the selected variables showed a significant statistical correlation with the CPPopt yield.
Conclusion: In this retrospective multicenter study, none of the selected admission and treatment variables were related to the CPPopt yield.
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Acknowledgements
The data used here were collected as part of a study supported by the European Union seventh Framework Programme (Grant 602150), Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (Center-TBI).
CENTER-TBI High-Resolution (HR ICU) Substudy Participants and Investigators : Audny Anke, Ronny Beer, BoMichael Bellander, Andras Buki, Marco Carbonara, Arturo Chieregato, Giuseppe Citerio, Endre Czeiter, Bart Depreitere, Shirin Frisvold, Raimund Helbok, Stefan Jankowski, Danile Kondziella, Lars-Owe Koskinen, Ana Kowark, David K. Menon, Geert Meyfroidt, Kirsten Moeller, David Nelson, Anna Piippo-Karjalainen, Andreea Radoi, Arminas Ragauskas, Rahul Raj, Jonathan Rhodes, Saulius Rocka, Rolf Rossaint, Juan Sahuquillo, Oliver Sakowitz, Nino Stocchetti, Nina Sundström, Riikka Takala, Tomas Tamosuitis, Olli Tenovuo, Peter Vajkoczy, Alessia Vargiolu, Rimantas Vilcinis, Stefan Wolf, Alexander Younsi.
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MC is supported by NIHR, Biomedical Research Centre, Cambridge, UK.
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Liberti, A. et al. (2021). Patient’s Clinical Presentation and CPPopt Availability: Any Association?. 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_34
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