Blood Pressure Variability and Optimal Cerebral Perfusion Pressure-New Therapeutic Targets in Traumatic Brain Injury

被引:33
作者
Wettervik, Teodor Svedung [1 ]
Howells, Timothy [1 ]
Lewen, Anders [1 ]
Enblad, Per [1 ]
机构
[1] Uppsala Univ, Dept Neurosci, Sect Neurosurg, S-75185 Uppsala, Sweden
关键词
Autoregulation; Blood pressure variability; CPPopt; Traumatic brain injury; HEART-RATE-VARIABILITY; REACTIVITY; MANAGEMENT; GUIDELINES;
D O I
10.1093/neuros/nyz515
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Optimal cerebral perfusion pressure (CPPopt) is an autoregulatory-oriented target in the neurointensive care (NIC) of patients with traumatic brain injury (TBI), and deviation from CPPopt is associated with poor outcome. We recently found that blood pressure variability (BPV) is associated with deviation from CPPopt. OBJECTIVE: To evaluate BPV and other variables related to deviation from CPPopt and to evaluate challenges and strategies for autoregulatory-oriented treatment in TBI. METHODS: Data including arterial blood pressure and intracranial pressure (ICP) from 362 TBI patients treated at the NIC unit, Uppsala University Hospital, Sweden, between 2008 and 2016, were retrospectively analyzed day 2 to 5. RESULTS: Higher BPV was a strong predictor of both CPP deviation below and above CPPopt after multiple regression analyses. There was no other explanatory variable for CPP deviation above CPPopt, whereas also higher ICP and worse autoregulation (higher pressure reactivity index) were associated with CPP deviation below CPPopt. A higher BPV was, in turn, explained by older age, lower ICP, higher mean arterial blood pressure, and higher slow arterial blood pressure amplitude (0.018-0.067 Hz). CONCLUSION: BPV was strongly associated with deviation from CPPopt. High age is a risk factor for high BPV and hence CPP insults. Our treatment protocol is focused on avoiding CPP below 60 mm Hg. It is possible that a more restrictive upper level could generate more stable blood pressure and less deviation from CPPopt.
引用
收藏
页码:E300 / E309
页数:10
相关论文
共 34 条
[21]   Relationship Between Short-Term Blood Pressure Variability and Large-Artery Stiffness in Human Hypertension Findings From 2 Large Databases [J].
Schillaci, Giuseppe ;
Bilo, Grzegorz ;
Pucci, Giacomo ;
Laurent, Stephane ;
Macquin-Mavier, Isabelle ;
Boutouyrie, Pierre ;
Battista, Francesca ;
Settimi, Laura ;
Desamericq, Gaelle ;
Dolbeau, Guillaume ;
Faini, Andrea ;
Salvi, Paolo ;
Mannarino, Elmo ;
Parati, Gianfranco .
HYPERTENSION, 2012, 60 (02) :369-+
[22]   Identification of blood pressure control mechanisms by power spectral analysis [J].
Stauss, Harald M. .
CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, 2007, 34 (04) :362-368
[23]   Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury [J].
Steiner, LA ;
Czosnyka, M ;
Piechnik, SK ;
Smielewski, P ;
Chatfield, D ;
Menon, DK ;
Pickard, JD .
CRITICAL CARE MEDICINE, 2002, 30 (04) :733-738
[24]   Impaired baroreflex sensitivity predicts outcome of acute intracerebral hemorrhage [J].
Sykora, Marek ;
Diedler, Jennifer ;
Rupp, Andre ;
Turcani, Peter ;
Rocco, Andrea ;
Steiner, Thorsten .
CRITICAL CARE MEDICINE, 2008, 36 (11) :3074-3079
[25]   Autonomic Impairment in Severe Traumatic Brain Injury: A Multimodal Neuromonitoring Study [J].
Sykora, Marek ;
Czosnyka, Marek ;
Liu, Xiuyun ;
Donnelly, Joseph ;
Nasr, Nathalie ;
Diedler, Jennifer ;
Okoroafor, Francois ;
Hutchinson, Peter ;
Menon, David ;
Smielewski, Peter .
CRITICAL CARE MEDICINE, 2016, 44 (06) :1173-1181
[26]   Baroreflex: A New Therapeutic Target in Human Stroke? [J].
Sykora, Marek ;
Diedler, Jennifer ;
Turcani, Peter ;
Hacke, Werner ;
Steiner, Thorsten .
STROKE, 2009, 40 (12) :E678-E682
[27]   Subacute perihematomal edema in intracerebral hemorrhage is associated with impaired blood pressure regulation [J].
Sykora, Marek ;
Diedler, Jennifer ;
Turcani, Peter ;
Rupp, Andre ;
Steiner, Thorsten .
JOURNAL OF THE NEUROLOGICAL SCIENCES, 2009, 284 (1-2) :108-112
[28]   Analyzing outcome of treatment of severe head injury: A review and update on advancing the use of the Glasgow Outcome Scale [J].
Teasdale, GM ;
Pettigrew, LEL ;
Wilson, JTL ;
Murray, G ;
Jennett, B .
JOURNAL OF NEUROTRAUMA, 1998, 15 (08) :587-597
[29]   Measurement of pulse wave velocity: site matters [J].
Tillin, Therese ;
Chambers, John ;
Malik, Iqbal ;
Coady, Emma ;
Byrd, Sheila ;
Mayet, Jamil ;
Wright, Andrew R. ;
Kooner, Jaspal ;
Shore, Angela ;
Thom, Simon ;
Chaturvedi, Nish ;
Hughes, Alun .
JOURNAL OF HYPERTENSION, 2007, 25 (02) :383-389
[30]   Temporal Neurophysiological Dynamics in Traumatic Brain Injury: Role of Pressure Reactivity and Optimal Cerebral Perfusion Pressure for Predicting Outcome [J].
Wettervik, Teodor Svedung ;
Howells, Timothy ;
Enblad, Per ;
Lewen, Anders .
JOURNAL OF NEUROTRAUMA, 2019, 36 (11) :1818-1827