Cerebral Perfusion Pressure Variability Between Patients and Between Centres.

Area of Science:

• Neuroscience
• Intensive Care Medicine
• Neurosurgery

Background:

• Severe traumatic brain injury (TBI) necessitates careful management of cerebral perfusion pressure (CPP) to optimize outcomes.
• International guidelines, such as those from the Brain Trauma Foundation, provide thresholds for CPP management.
• Variability in clinical practice across different medical centers can impact patient care and outcomes.

Purpose of the Study:

• To analyze the variability of median cerebral perfusion pressure (CPP) among severe traumatic brain injury (TBI) patients across multiple centers.
• To assess whether the 2007 revision of CPP guidelines by the Brain Trauma Foundation influenced clinical practice in different centers.
• To examine trends in CPP management over time in relation to guideline changes.

Main Methods:

• Utilized data from the multi-center Brain-IT database (2003-2005) and a subsequent project (2009-2013).
• Corrected CPP values for head elevation (30°) and transducer level.
• Calculated median CPP, interquartile ranges, and total CPP ranges per patient and per center.

Main Results:

• Pre-2007, 10 out of 16 centers had median CPPs above 70 mmHg, with 4 above 80 mmHg.
• Post-2007, 3 out of 4 centers showed median CPPs between 60-70 mmHg, and 1 remained above 80 mmHg.
• One center shifted from a median CPP of 76 mmHg to 60 mmHg post-2007, while another maintained levels around 67-68 mmHg.

Conclusions:

• Significant inter-individual variability in CPP exists, alongside evidence of differing CPP management policies between centers.
• The 2007 guideline revision may have prompted a shift towards lower CPP targets in some centers.
• Observed deviations from guidelines, particularly maintaining CPP above 70 mmHg, indicate ongoing variability in practice.