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Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model
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Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model

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Optimal cerebral perfusion pressure in patients with intracerebral hemorrhage: an observational case series

Jennifer Diedler, Edgar Santos, Sven Poli

    Critical Care (London, England)
    |March 27, 2014
    PubMed

    Insights

    Impaired cerebral autoregulation is common in patients with intracerebral hemorrhage (ICH) and linked to poor outcomes. Real-time monitoring of optimal cerebral perfusion pressure (CPPopt) is feasible and may guide future ICH management strategies.

    Area of Science:

    • Neurology
    • Critical Care Medicine
    • Neurocritical Care

    Background:

    • Current guidelines recommend maintaining cerebral perfusion pressure (CPP) between 50-70 mmHg in spontaneous intracerebral hemorrhage (ICH) patients.
    • Dynamic cerebral autoregulation and optimal CPP (CPPopt) assessment are crucial for personalized management.
    • Understanding the relationship between autoregulation, CPPopt, and patient outcomes is essential.

    Purpose of the Study:

    • To continuously assess dynamic cerebral autoregulation in ICH patients.
    • To determine the feasibility of identifying an optimal CPP (CPPopt) in ICH.
    • To explore associations between autoregulation, CPPopt, and functional outcomes.

    Main Methods:

    • Continuous monitoring of intracranial pressure (ICP), mean arterial pressure (MAP), and CPP in 38 ICH patients.
    • Calculation of the pressure reactivity index (PRx) as the correlation between MAP and ICP.
    • Definition of CPPopt as the CPP associated with the lowest PRx values, assessed hourly.
    • Evaluation of functional outcome using the modified Rankin Scale (mRS) at 3 months.

    Main Results:

    • Impaired pressure reactivity (PRx > 0.2) was observed in 47% of patients.
    • Both mean PRx and time spent with PRx > 0.2 correlated significantly with mRS at 3 months.
    • CPPopt was calculable during 57% of monitoring time; median CPPopt was 83 mmHg.
    • Time with impaired autoregulation and hemorrhage volume were independent predictors of acceptable outcome (mRS 1-4).

    Conclusions:

    • Impaired pressure reactivity is frequent in severe ICH and associated with unfavorable outcomes.
    • Real-time CPPopt assessment is feasible in ICH patients.
    • CPPopt management may offer a novel approach for autoregulation-oriented CPP management in ICH, warranting larger trials.
    Abstract

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