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A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients
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A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

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Temporal dynamics of ICP, CPP, PRx, and CPPopt in relation to outcome in spontaneous intracerebral hemorrhage

Rozerin Kevci, Anders Hånell, Timothy Howells

    Journal of Neurosurgery
    |February 21, 2025
    PubMed

    Insights

    Maintaining cerebral perfusion pressure (CPP) above 80 mm Hg and avoiding high intracranial pressure (ICP) may improve outcomes for spontaneous intracerebral hemorrhage (sICH) patients. Pressure reactivity index (PRx) did not independently predict outcomes but influenced safe ICP and CPP ranges.

    Area of Science:

    • Neurocritical care
    • Neurology
    • Intensive care medicine

    Background:

    • Optimal neurointensive care (NIC) targets for spontaneous intracerebral hemorrhage (sICH) remain understudied.
    • The role of cerebral pressure autoregulatory disturbances, such as the pressure reactivity index (PRx), needs clarification in sICH.
    • The superiority of autoregulatory CPP targets (CPPopt) over fixed CPP targets in sICH requires investigation.

    Purpose of the Study:

    • To explore the role of intracranial pressure (ICP), PRx, cerebral perfusion pressure (CPP), and CPPopt in sICH patients.
    • To determine optimal ICP and CPP thresholds for sICH management in the NIC unit.
    • To assess the impact of autoregulatory disturbances on outcomes in sICH.

    Main Methods:

    • Observational study of 184 adult sICH patients with ICH volume > 10 ml.
    • Included patients with > 12 hours of ICP monitoring within the first 7 days.
    • Analyzed ICP, CPP, PRx, and CPPopt in relation to clinical outcomes (favorable vs. unfavorable).

    Main Results:

    • 75% of patients had a favorable outcome (conscious at discharge).
    • Lower ICP (> 25 mm Hg) and higher CPP (> 80 mm Hg) were independently associated with favorable outcomes.
    • PRx did not independently correlate with outcome, but higher PRx values narrowed safe ICP and CPP ranges.

    Conclusions:

    • Maintaining CPP > 80 mm Hg and avoiding ICP > 20-25 mm Hg may benefit sICH patients with large ICH volumes.
    • PRx was not an independent predictor but indicated altered cerebrovascular pressure regulation.
    • Further research is needed to refine NIC targets for sICH management.
    Abstract

    Keywords:
    cerebral autoregulationcerebral perfusion pressureintracerebral hemorrhageintracranial pressureneurointensive careoutcomevascular disorders

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