eprintid: 19484
rev_number: 15
eprint_status: archive
userid: 1589
dir: disk0/00/01/94/84
datestamp: 2016-01-19 09:50:22
lastmod: 2024-04-09 08:22:33
status_changed: 2016-01-19 09:50:22
type: article
metadata_visibility: show
creators_name: Diedler, Jennifer
creators_name: Santos, Edgar
creators_name: Poli, Sven
creators_name: Sykora, Marek
title: Optimal cerebral perfusion pressure in patients with intracerebral hemorrhage: an observational case series
subjects: ddc-610
divisions: i-911100
abstract: Introduction: Current guidelines for spontaneous intracerebral hemorrhage (ICH) recommend maintaining cerebral perfusion pressure (CPP) between 50 and 70 mmHg, depending on the state of autoregulation. We continuously assessed dynamic cerebral autoregulation and the possibility of determination of an optimal CPP (CPPopt) in ICH patients. Associations between autoregulation, CPPopt and functional outcome were explored.   Methods: Intracranial pressure (ICP), mean arterial pressure (MAP) and CPP were continuously recorded in 55 patients, with 38 patients included in the analysis. The pressure reactivity index (PRx) was calculated as moving correlation between MAP and ICP. CPPopt was defined as the CPP associated with the lowest PRx values. CPPopt was calculated using hourly updated of 4 hour windows. The modified Rankin Scale (mRS) was assessed at 3 months and associations between PRx, CPPopt and outcomes were explored using Pearson correlation and Fisher’s exact test. Multivariate stepwise logistic regression models were calculated including standard outcome predictors along with percentage of time with PRx >0.2 and percentage of time within the CPPopt range.   Results: An overall PRx indicating impairment of pressure reactivity was found in 47% of patients (n = 18). The mean PRx and the time spent with a PRx > 0.2 significantly correlated with mRS at 3 months (r = 0.50, P = 0.002; r = 0.46, P = 0.004). CPPopt was calculable during 57% of the monitoring time. The median CPP was 78 mmHg, the median CPPopt 83 mmHg. Mortality was lowest in the group of patients with a CPP close to their CPPopt. However, for none of the CPPopt variables a significant association to outcome was found. The percentage of time with impaired autoregulation and hemorrhage volume were independent predictors for acceptable outcome (mRS 1 to 4) at three months.   Conclusions: Failure of pressure reactivity seems common following severe ICH and is associated with unfavorable outcome. Real-time assessment of CPPopt is feasible in ICH and might provide a tool for an autoregulation-oriented CPP management. A larger trial is needed to explore if a CPPopt management results in better functional outcomes.  
date: 2014
publisher: BioMed Central
id_scheme: DOI
ppn_swb: 1656105578
own_urn: urn:nbn:de:bsz:16-heidok-194840
language: eng
bibsort: DIEDLERJENOPTIMALCER2014
full_text_status: public
publication: Critical care
volume: 18
number: R51
place_of_pub: London
pagerange: 1-8
issn: 1466-609X
citation:   Diedler, Jennifer ; Santos, Edgar ; Poli, Sven ; Sykora, Marek  (2014) Optimal cerebral perfusion pressure in patients with intracerebral hemorrhage: an observational case series.  Critical care, 18 (R51).  pp. 1-8.  ISSN 1466-609X     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/19484/1/13054_2013_Article_2868.pdf