Neuroanesthesia & neurocritical care
Critical thresholds of long-pressure reactivity index and impact of intracranial pressure monitoring methods in traumatic brain injury
Authors' conclusion
Our work suggests that the underlying prognostic factors causing impairment in cerebrovascular reactivity can, to some degree, be detected using lower resolution PRx metrics (similar found thresholding values) with LPRx found clinically using as low as 10 min-by-minute samples of MAP and ICP. Furthermore, EVD derived LPRx with intermittent cerebrospinal fluid draining, seems to present similar outcome capacity as IPD.
Study context
- Population
- Moderate-to-severe Traumatic Brain Injury (TBI) patients, Karolinska University Hospital
- Participants
- 435 patients
- Exposure
- LPRx thresholds across time-windows; External ventricular drains (EVD) vs intraparenchymal pressure device (IPD) intracranial pressure (ICP) monitoring
- Outcome
- Critical LPRx thresholds associated with 1-year Glasgow Outcome Scale (GOS) outcome:
- Alive vs dead
- Favorable vs unfavorable
- Follow-up
- 1 year
Methodological detailssingle-centre, observational
- Single-centre
- Observational
Main finding
As reported in the abstract
Critical LPRx thresholds
- LPRx with 10-120-min windows behaved similarly; maximal chi-square at LPRx of about 0.25-0.35, for survival and favorable outcome
Observational data: associations, not effects.
Further findings
Temporal relations of LPRx thresholds
- First 4 days appeared most associated with outcomes
LPRx thresholds by ICP monitoring method (EVD vs IPD)
- Limited differences between EVD and IPD, with similar LPRx values around 0.3
Original publication
Critical thresholds of long-pressure reactivity index and impact of intracranial pressure monitoring methods in traumatic brain injury. Crit Care. Published 29 July 2024. doi:10.
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