Adherence to guidelines for management of cerebral perfusion pressure and outcome in patients who have severe traumatic brain injury

Purpose: The aims of this study are to assess adherence to the Brain Trauma Foundation (BTF) cerebral perfusion pressure (CPP) guidelines and to determine if adherence is associated with mortality in patients who have a severe traumatic brain injury. Materials and methods: Retrospective cohort study of 127 patients admitted to one intensive care unit between 2006 and 2012. Adherence to BTF guidelines was measured as the time that the CPP was within 50 to 70 mm Hg divided by the total time of CPP monitoring (CPP time index). Results: The percentage of time that the CPP was within the recommended range was 31.6% (SD, 22.2); CPP was greater than 70 mm Hg for 63.9% (SD, 26.2) of the time and less than 50 mm Hg for 4.5% of the time (SD, 16.3). After adjustment for covariates, CPP time index (between 50 and 70 mm Hg) was not associated with hospital mortality (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.98-1.6; P=.079). The time indices for CPP >= 70 and <50 mm Hg were associated with decreased (OR, 0.66; 95% CI, 0.52-0.82; P<.0001) and increased (OR, 9.9; 95% CI, 1.4-69.6; P=.021) mortality, respectively. Conclusion: Cerebral perfusion pressure was greater than 70 mm Hg for most of the time. This level of CPP was associated with decreased hospital mortality. (C) 2014 Elsevier Inc. All rights reserved.