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The following is a summary of “Cerebral physiologic insult burden in acute traumatic neural injury: a Canadian High Resolution-TBI (CAHR-TBI) descriptive analysis,” published in the September 2024 issue of Critical Care by Stein et al.
Multi-modal monitoring of cerebral physiology has been rapidly increasing in recent decades for minimizing secondary brain injury after moderate-to-severe traumatic brain injury (TBI). However, a comprehensive evaluation of the impact of disturbances in multiple cerebral physiological parameters on overall cerebral insult burden still needs to be completed.
Researchers conducted a retrospective study to examine the associations between disrupted cerebral physiology and the burden of cerebral physiologic insult.
They used data from the Canadian High-Resolution TBI (CAHR-TBI) Research Collaborative to analyze 369 complete patient datasets, categorized into low, intermediate, and high cohorts based on mean values of various cerebral physiologic metrics. Jonckheere–Terpstra testing assessed the relationship between these metrics and different cerebral physiologic insult burden measures. Contour plots were created to visualize the impact of preserved versus impaired cerebrovascular reactivity on these relationships.
The results showed elevated intracranial pressure (ICP) was associated with increased cerebral perfusion pressure (CPP) time below 60 mmHg and impaired cerebrovascular reactivity. Low CPP was linked to more time with ICP above 20 or 22 mmHg and impaired cerebrovascular reactivity. Elevated cerebrovascular reactivity indices were associated with both lower CPP and higher ICP. Low brain tissue oxygenation (PbtO2) was significantly associated only with more time spent with CPP below 60 mmHg. Low regional oxygen saturation (rSO2) did not significantly correlate with any cerebral physiologic insult burden measure.
They concluded that mean ICP, CPP, and cerebrovascular reactivity values were significantly associated with global cerebral physiologic insult burden. Still, measures of oxygen delivery may not provide significant insights into this burden.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05083-y
