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Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP
Ulf Johnson1,2, Henrik Engquist3,4, Anders Lewén3
1Department of Neuroscience/Neurosurgery, Uppsala University, S-75185, Uppsala, Sweden. Ulf.johnson@neuro.uu.se.
Acta Neurochirurgica
|April 1, 2017
Summary
Optimal cerebral perfusion pressure (CPPopt) calculation is feasible in most severe subarachnoid hemorrhage (SAH) patients. Maintaining actual cerebral perfusion pressure (CPP) below CPPopt correlates with reduced cerebral blood flow (CBF).
Area of Science:
- Neurology
- Intensive Care Medicine
- Neurosurgery
Background:
- Cerebral pressure autoregulation, quantified by the pressure reactivity index (PRx), helps determine optimal cerebral perfusion pressure (CPPopt).
- The relationship between CPPopt and cerebral blood flow (CBF) in subarachnoid hemorrhage (SAH) patients remains underexplored.
Purpose of the Study:
- To assess the feasibility of calculating CPPopt in SAH patients.
- To investigate the association between CPPopt and CBF in SAH patients.
Main Methods:
- Retrospective analysis of prospectively collected data from 82 SAH patients.
- Cerebral blood flow (CBF) measured using Xenon-enhanced CT (Xe-CT).
- Correlation analysis between the difference in actual CPP and CPPopt (CPP∆) and CBF parameters.
Main Results:
- Automated CPPopt calculation was successful in 60% of Xe-CT scans.
- Actual CPP below CPPopt was significantly associated with increased low-flow regions (CBF < 10 ml/100 g/min) in both early (day 0-3) and late (day 4-14) acute phases.
- CPP level itself did not show a direct association with CBF.
Conclusions:
- CPPopt can be calculated in the majority of severe SAH patients.
- Actual CPP below the calculated CPPopt is linked to reduced cerebral blood flow.