Time spent above optimal cerebral perfusion pressure is not associated with failure to improve in outcome in traumatic brain injury

Stein, Kevin Y.; Froese, Logan; Gomez, Alwyn; Sainbhi, Amanjyot Singh; Vakitbilir, Nuray; Ibrahim, Younis; Islam, Abrar; Marquez, Izabella; Amenta, Fiorella; Bergmann, Tobias; Zeiler, Frederick A.

doi:10.1186/s40635-023-00579-3

Intensive Care Medicine Experimental

Table 5 Added variance in transition in outcome from cerebrovascular reactivity measures over IMPACT Core ± CT ± ICP > 20 or 22 mmHg

From: Time spent above optimal cerebral perfusion pressure is not associated with failure to improve in outcome in traumatic brain injury

Variable	1 month → 3 months	3 month → 6 months	1 month → 6 months
Δ Nagelkerke’s R²
Core
CPPopt–PRx	0	0.035	0.009
% Time ΔCPPopt–PRx > 5 mmHg	0.014	0.027	0.063
% Time ΔCPPopt–PRx > 10 mmHg	0.037	0.034	0.089
% Time ΔCPPopt–PRx < −5 mmHg	0.003	0.010	0.029
% Time ΔCPPopt–PRx < −10 mmHg	0.001	0.003	0.019
% Time CPP > ULR–PRx	0.003	0.142	0.047
% Time CPP < LLR–PRx	0.013	0.002	0.019
CPPopt–PAx	0.009	0.025	0.032
% Time ΔCPPopt–PAx > 5 mmHg	0.018	0.065	0.047
% Time ΔCPPopt–PAx > 10 mmHg	0.035	0.082	0.091
% Time ΔCPPopt–PAx < −5 mmHg	0.007	0.043	0.001
% Time ΔCPPopt–PAx < −10 mmHg	0.009	0.021	0
% Time CPP > ULR–PAx	0.075	0.069	0
% Time CPP < LLR–PAx	0.088	0.005	0.064
CPPopt–RAC	0.016	0.023	0.034
% Time ΔCPPopt–RAC > 5 mmHg	0.004	0.064	0.041
% Time ΔCPPopt–RAC > 10 mmHg	0.033	0.045	0.078
% Time ΔCPPopt–RAC < −5 mmHg	0.005	0.016	0.008
% Time ΔCPPopt–RAC < −10 mmHg	0.003	0.001	0.001
% Time CPP > ULR–RAC	0.037	0.052	0.005
% Time CPP < LLR–RAC	0.039	0.001	0.019
Core + CT
CPPopt–PRx	0	0.025	0.008
% Time ΔCPPopt–PRx > 5 mmHg	0.014	0.021	0.064
% Time ΔCPPopt–PRx > 10 mmHg	0.040	0.023	0.092
% Time ΔCPPopt–PRx < −5 mmHg	0.002	0.014	0.027
% Time ΔCPPopt–PRx < −10 mmHg	0.001	0.007	0.020
% Time CPP > ULR–PRx	0.003	0.130	0.049
% Time CPP < LLR–PRx	0.014	0	0.023
CPPopt–PAx	0.008	0.018	0.026
% Time ΔCPPopt–PAx > 5 mmHg	0.023	0.063	0.056
% Time ΔCPPopt–PAx > 10 mmHg	0.046	0.073	0.112
% Time ΔCPPopt–PAx < −5 mmHg	0.006	0.044	0.002
% Time ΔCPPopt–PAx < −10 mmHg	0.007	0.025	0
% Time CPP > ULR–PAx	0.077	0.066	0
% Time CPP < LLR–PAx	0.098	0.008	0.079
CPPopt–RAC	0.013	0.018	0.028
% Time ΔCPPopt–RAC > 5 mmHg	0.006	0.062	0.049
% Time ΔCPPopt–RAC > 10 mmHg	0.042	0.038	0.096
% Time ΔCPPopt–RAC < −5 mmHg	0.003	0.017	0.012
% Time ΔCPPopt–RAC < −10 mmHg	0.002	0.002	0.003
% Time CPP > ULR–RAC	0.036	0.053	0.005
% Time CPP < LLR–RAC	0.041	0.002	0.020
Core + CT + ICP > 20 mmHg
CPPopt–PRx	0.002	0.026	0.010
% Time ΔCPPopt–PRx > 5 mmHg	0.002	0.015	0.030
% Time ΔCPPopt–PRx > 10 mmHg	0.020	0.018	0.056
% Time ΔCPPopt–PRx < −5 mmHg	0.010	0.008	0.001
% Time ΔCPPopt–PRx < −10 mmHg	0.022	0.002	0.001
% Time CPP > ULR–PRx	0.002	0.130	0.045
% Time CPP < LLR–PRx	0	0.006	0
CPPopt–PAx	0.004	0.016	0.016
% Time ΔCPPopt–PAx > 5 mmHg	0.014	0.057	0.037
% Time ΔCPPopt–PAx > 10 mmHg	0.035	0.068	0.086
% Time ΔCPPopt–PAx < −5 mmHg	0.020	0.037	0
% Time ΔCPPopt–PAx < −10 mmHg	0.024	0.020	0.004
% Time CPP > ULR–PAx	0.031	0.085	0.006
% Time CPP < LLR–PAx	0.028	0.001	0.014
CPPopt–RAC	0.007	0.015	0.015
% Time ΔCPPopt–RAC > 5 mmHg	0.002	0.056	0.033
% Time ΔCPPopt–RAC > 10 mmHg	0.036	0.036	0.081
% Time ΔCPPopt–RAC < −5 mmHg	0.018	0.013	0.002
% Time ΔCPPopt–RAC < −10 mmHg	0.016	0	0.001
% Time CPP > ULR–RAC	0.006	0.077	0.030
% Time CPP < LLR–RAC	0	0.019	0.004
Core + CT + ICP > 22 mmHg
CPPopt–PRx	0.003	0.026	0.010
% Time ΔCPPopt–PRx > 5 mmHg	0.002	0.014	0.028
% Time ΔCPPopt–PRx > 10 mmHg	0.021	0.018	0.056
% Time ΔCPPopt–PRx < −5 mmHg	0.011	0.007	0.001
% Time ΔCPPopt–PRx < −10 mmHg	0.024	0.001	0.001
% Time CPP > ULR–PRx	0.001	0.131	0.047
% Time CPP < LLR–PRx	0.001	0.007	0
CPPopt–PAx	0.005	0.016	0.016
% Time ΔCPPopt–PAx > 5 mmHg	0.012	0.056	0.034
% Time ΔCPPopt–PAx > 10 mmHg	0.037	0.067	0.085
% Time ΔCPPopt–PAx < −5 mmHg	0.022	0.037	0
% Time ΔCPPopt–PAx < −10 mmHg	0.024	0.020	0.004
% Time CPP > ULR–PAx	0.028	0.086	0.006
% Time CPP < LLR–PAx	0.024	0.001	0.013
CPPopt–RAC	0.008	0.015	0.015
% Time ΔCPPopt–RAC > 5 mmHg	0.001	0.055	0.030
% Time ΔCPPopt–RAC > 10 mmHg	0.035	0.035	0.078
% Time ΔCPPopt–RAC < −5 mmHg	0.019	0.013	0.001
% Time ΔCPPopt–RAC < −10 mmHg	0.016	0	0.001
% Time CPP > ULR–RAC	0.005	0.078	0.031
% Time CPP < LLR–RAC	0	0.019	0.005

The Core model consisted of age, admission Glasgow Coma Scale—motor score, and admission pupillary response. CT variables consisted of admission Marshall CT grade, presence of traumatic subarachnoid hemorrhage, and presence of epidural hematoma
AMP pulse amplitude of ICP, CPP cerebral perfusion pressure, CPPopt cerebral perfusion pressure optimum, ΔCPPopt CPP—CPPopt, CT computed tomography, ICP intracranial pressure, LLR lower limit of reactivity, PAx pulse amplitude index, PRx pressure reactivity index, RAC correlation (R) between slow-waves of AMP (A) and CPP (C), ULR upper limit of reactivity

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