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Citation |
Muehlschlegel S. Neurocrit. Care 2019; ePub(ePub): ePub. |
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Affiliation |
Departments of Neurology, Anesthesiology and Surgery, University of Massachusetts Medical School, 55 Lake Ave North, S-5, Worcester, MA, USA. susanne.muehlschlegel@umassmed.edu. |
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Copyright |
(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group) |
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DOI |
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PMID |
31845171 |
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Abstract |
When it comes to intracranial pressure (ICP) and cerebral perfusion pressure (CPP) targets in traumatic brain injury (TBI), the notion that “one size does not fit all” has been displayed by several important studies. For example, investigators from the Cambridge brain physics laboratory have first reported in 2002 [1] and recently validated in a large CENTER-TBI cohort in 2019 [2] that applying patient-individualized CPP and ICP targets using the relationship between ICP and the cerebrovascular pressure reactivity index (PRx), a moving correlation coefficient recorded over several minute periods between averaged values of MAP and ICP, is independently associated with better outcome than using guideline-recommended ICP thresholds. Also, the “BEST-TRIP trial,” a large NIH-funded Phase-3 trial in severe TBI, showed that maintaining a non-individualized ICP at 20 mmHg or less for all patients was not superior than imaging and clinical examination [3]. Nonetheless, real-time or just even retrospective PRx monitoring remains limited to very few neuro-ICUs around the world, due to practical reasons: the need for high-resolution monitoring, which requires hardware and software additions (read: costs for licensing, training and acquisition), technical expertise in software and hardware use, and time. Language: en |