Treatment of the best brain perfusion pressure in patients with severe TBI

Traumatic brain injury (TBI) secondary cerebrovascular autoregulation (cerebrovascular autoregulation, CA) function changes, affecting the patient's clinical prognosiscontinuous bedside CA monitoring of Comatocation patients in TBI is essential to establish the best, personalized treatment objectivesthe optimal cerebral perfusion pressure (CPPopt) is the minimum CPP value for the Pressure Reactivity Index (PRx) and the CPP U-shaped relationship (U-shaped relationship)the treatment targeted at CPPopt in severe TBI patients is a new view:maintain a complete CBF auto-regulation function when the CPP is away from the dynamic lower and upper limits of auto-regulationpatientage and intracranial pressure (ICP) are also factors associated with clinical prognosis in patients with severe TBIstudy by Vytautas Petkus, Institute for Health Telematics Processing at Kaunas University of Technology, Lithuania, compared the effects of CPPopt therapy on ICP normality and elevation, age 45 and 45 years of TBI, andalso determined factors that affect the prognosis, including age, Bias of CPP and CPPopt values (CPPopt), ICP, TBI severity, serum glucose level severity and cerebrovascular auto-regulationresults were published in the January 2020 issue of Journal of Neurotraumaresultsresearchers reviewed the data of TBI patients who received CPPopt treatment at the neurosurgery ICUA total of 81 cases of continuous multimodal monitoring were included in thein severe TBI patients who monitored arterial pressure (ABP) (t), ICP (t), CPP (t) and CPPopt (t)use ICM plus software to continuously evaluate CPPopt (t) status by identifying the pressure reactivity index (PRx)the best real-time CPP (t) calculation of the CPPopt (t) - CPP (t) - CPPopt (t)the physiological parameters of The Prognosis, Demographicdata, and Monitoring of TBI Patients are detailed in Table 1Table 1 Demographic and multi-modal monitoring data for TBI patients The prognosis of patients with was significantly correlated with age and average ICP, and the age 45 years and above 21.3mmHg were associated with poor prognosis (Figure 1) Figure 1 The pre-prognosis of TBI patients was associated with age and average intracranial pressure the average CPP value close to CPPopt was well associated with the prognosis of patients aged 45 the average CPPopt (5.0mmHg), average PRx 0.36 and LCAI 100min were significantly associated with mortality rates in patients in the 45-year-old group the the critical values of an average of 0.26 pRx and LCAI 61min were significantly related to mortality in patients in the 45-year-old group (Figures 2, 3, 4) in addition, LCAI 58min was significantly associated with mortality in patients with elevated traumatic brain injury in ICP (Figure 4) Figure 2 The correlation between average PRx and the prognosis of the average ICP (22mmHg) and the 22mmHg patients aged 45 and 45 with TBI Figure 3 Correlation between the average CPPopt and the average ICP normal (22 mmHg) and the prognosis of 45-year-old and 45-year-old TBI patients Figure 4 The correlation between LCAI and the prognosis of 45-year-old and 45-year-old TBI patients with normal ICP (22mmHg) and elevated (22mmHg) multi-factor binary logic regression model, significantly affecting the prognosis of TBI patients, including age, GCS score, serum glucose measured within 24h of admission, and LCAI duration at PRx (t) and 0.5 in admission 24 h The accuracy of the good prognosis and the poor prediction modeling of the prognosis of was 86.5% and 90.9%, respectively, and the overall model accuracy was 88.6% (Table 2) Table 2 Multi-factor logistic regression model for predicting good prognosis and poor prognosis in TBI patients Conclusion
study final results showed that the degree and duration of deviation from CPPopt were associated with increased mortality in the 45-year-old group, effective treatment for PopCPt in the 45-year-old group; patients in the 45-year-old group who 45 years of age could tolerate and survive in conditions with more severe CA impairment; and patients in the 45-year-old group may require higher CPP the monitoring of cerebrovascular autoregulation within the first 24 hours is important, especially in patients in the 45-year-old group who were able to tolerate impaired cerebrovascular auto-regulation function for shorter periods of time than those in the 45-year-old group , the treatment of autovascular regulation is important for TBI patients, especially in the 45-year-old group, but the results of this study need further multicenter randomized clinical trials to confirm.