Escalating Mean Arterial Pressure in Severe Traumatic Brain Injury: A Prospective, Observational Study.

Autor:	Kow CY; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia.; National Trauma Research Institute, Melbourne, Victoria, Australia., Harley B; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia.; National Trauma Research Institute, Melbourne, Victoria, Australia., Li C; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia.; National Trauma Research Institute, Melbourne, Victoria, Australia., Romo P; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia., Gkolia P; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia., Lu KY; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Bell C; Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia., Jithoo R; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia., Tee J; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia.; National Trauma Research Institute, Melbourne, Victoria, Australia.; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia., Cooper DJ; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.; Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia., Rosenfeld JV; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia.; Department of Surgery, and Monash University, Clayton, Victoria, Australia., Lewis PM; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.; Department of Electrical and Computer Systems Engineering, Monash University, Clayton, Victoria, Australia., Udy A; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.; Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia., Hunn M; Neurosurgery Department, Alfred Hospital, Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Journal of neurotrauma [J Neurotrauma] 2021 Jul 15; Vol. 38 (14), pp. 1995-2002. Date of Electronic Publication: 2021 Jan 29.
DOI:	10.1089/neu.2020.7289
Abstrakt:	To investigate cerebral autoregulatory status in patients with severe traumatic brain injury (TBI), guidelines now suggest active manipulation of mean arterial pressure (MAP). There is a paucity of data, however, describing the effect on intracranial pressure (ICP) when MAP is raised. Consecutive patients with TBI requiring ICP monitoring were enrolled from November 2019 to April 2020. The MAP and ICP were recorded continuously, and clinical annotations were made whenever intravenous vasopressors were commenced or adjusted to defend cerebral perfusion pressure (CPP) targets. A significant change in MAP burden was defined as MAP >100min.mm Hg over 15 min. The primary outcome was the change in ICP burden over the same 15-min period. Bedside and clinical parameters were then compared between these groups. Twenty-eight patients were enrolled, providing 212 clinical events, of which 60 were deemed significant. Over the first 15 min, 65% were associated with a net negative ICP burden. A greater reduction in ICP burden was observed with events occurring in patients without a history of hypotension at scene ( p  = 0.016), after three days post-injury ( p  = 0.0018), and where the pressure-reactivity index (PRx) was <0.25 ( p  = 0.0005) or the ICP amplitude to CPP correlation coefficient (RAC) was <-0.10 ( p  = 0.0036) at the initiation of vasopressor changes. The ICP burden in the first 15 min was highly correlated with the next 15-min period. In patients with severe TBI requiring ICP monitoring, increasing MAP to pursue a CPP target was followed by a net negative ICP burden in approximately two-thirds of events. These data suggest a MAP challenge may be a useful adjunct in managing intracranial hypertension.
Databáze:	MEDLINE
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