Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis

• DOI: 10.1007/s00701-019-03980-8
• Publication Date: 2019-06-25T13:10:47Z
• Authors: Frederick A. Zeiler; Ari Ercole; Erta Beqiri; Manuel Cabeleira; Marcel Aries; Tommaso Zoerle; Marco Carbonara; Nino Stocchetti; Peter Smielewski; Marek Czosnyka; David K. Menon
• Keywords: Trauma Center

Impaired cerebrovascular reactivity in adult traumatic brain injury (TBI) is known to be associated with poor outcome. However, there has yet an analysis of the association between comprehensively assessed intracranial hypertension therapeutic intensity level (TIL) and reactivity. Using Collaborative European Neuro Trauma Effectiveness Research TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived pressure index (PRx) as moving correlation coefficient slow-wave ICP mean arterial pressure, updated every minute. Mean daily PRx, % time above PRx 0 were calculated for first 7 days ICU stay. This data was linked TIL-Intermediate scores, including total individual treatment sub-scores. Daily variable values compared each TIL score via mean, standard deviation, Mann U test (Bonferroni correction multiple comparisons). General fixed effects mixed models versus created display relation A 249 patients 1230 high frequency physiology matched TIL, assessed. Total unrelated PRx. Most sub-scores failed a significant relationship variables. Mild hyperventilation (p < 0.0001), mild hypothermia = levels sedation control use vasopressors CPP management 0.0001) found only modest decrease or 0. Cerebrovascular remains relatively independent intensity, suggesting inadequacy current therapies modulating impaired autoregulation. These findings support need investigation into molecular mechanisms involved, individualized physiologic targets (ICP, CPP, Co2) order treat dysautoregulation actively.