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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
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Lung Injury Risk in Traumatic Brain Injury Managed With Optimal Cerebral Perfusion Pressure Guided-Therapy.

Celeste Dias1,2, Alexandre de Castro1, Rita Gaio3,4

  • 1Faculty of Medicine, University of Porto, Porto, Portugal.

Journal of Critical Care Medicine (Universitatea De Medicina Si Farmacie Din Targu-Mures)
|August 18, 2023
PubMed
Summary

Optimal CPP-guided therapy for traumatic brain injury (TBI) appears safe, reducing secondary lung injury risks. This approach balances brain protection with systemic complications, improving patient outcomes.

Keywords:
ARDSacute lung injuryautoregulationdriving pressureoptimal cerebral perfusion pressurepressure reactivity indextraumatic brain injury

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Area of Science:

  • Neurocritical care
  • Intensive care medicine
  • Traumatology

Background:

  • Traumatic brain injury (TBI) management requires balancing secondary brain injury prevention with systemic complications like acute respiratory distress syndrome (ARDS).
  • Therapeutic decisions for TBI, such as fluid restriction and high PEEP, may negatively impact neurological outcomes.
  • Maintaining optimal cerebral perfusion pressure (CPP) is crucial, as both low CPP and excessively high CPP can lead to adverse outcomes.

Purpose of the Study:

  • To evaluate the safety of individualized optimal CPP (CPPopt)-guided therapy in severe TBI patients.
  • To assess the association between CPPopt-guided therapy and the risk of secondary lung injury.
  • To determine the impact of CPPopt-guided therapy on patient outcomes.

Main Methods:

  • Retrospective analysis of 92 severe TBI patients managed with CPPopt-guided therapy using pressure reactivity index (PRx).
  • Data collected included blood gas, ventilation, and brain variables over the first 10 days.
  • Linear mixed-effects regression models were used to analyze temporal changes.

Main Results:

  • The study included 92 patients (86% male, mean age 53 years), with 49% presenting multiple trauma.
  • Mean CPP was 86±7 mmHg, with CPP-CPPopt of -2.8±10.2 mmHg and PRx of 0.03±0.19.
  • No significant effect of CPP or CPPopt on the PaO2/FiO2 ratio was observed, but PRx and driving pressure were negatively associated with PFratio. A significant positive association was found between outcome and the difference CPP-CPPopt.

Conclusions:

  • CPPopt-guided therapy in severe TBI patients is associated with better outcomes.
  • This therapeutic strategy appears safe concerning the development of secondary lung injury.
  • Individualized CPP management may be a key factor in improving both neurological and systemic outcomes in TBI.