患者的临床表现与 CPPopt 的可用性：有任何关联吗？

Patient's Clinical Presentation and CPPopt Availability: Any Association?

机构信息

Department of Intensive Care, University Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.

Department of Physiology and Transplantation, Milan University, Milan, Italy.

出版信息

Acta Neurochir Suppl. 2021;131:167-172. doi: 10.1007/978-3-030-59436-7_34.

DOI:10.1007/978-3-030-59436-7_34

PMID:33839840

Abstract

BACKGROUND

The 'optimal' CPP (CPPopt) concept is based on the vascular pressure reactivity index (PRx). The feasibility and effectiveness of CPPopt guided therapy in severe traumatic brain injury (TBI) patients is currently being investigated prospectively in the COGiTATE trial. At the moment there is no clear evidence that certain admission and treatment characteristics are associated with CPPopt availability (yield).

OBJECTIVE

To test the relation between patients' admission and treatment characteristics and the average CPPopt yield.

METHODS

Retrospective analysis of 230 patients from the CENTER-TBI high-resolution database with intracranial pressure (ICP) measured using an intraparenchymal probe. CPPopt was calculated using the algorithm set for the COGiTATE study. CPPopt yield was defined as the percentage of CPP monitored time (%) when CPPopt is available. The variables in the statistical model included age, admission Glasgow Coma Scale (GCS), gender, pupil response, hypoxia and hypotension at the scene, Marshall computed tomography (CT) score, decompressive craniectomy, injury severity score score and 24-h therapeutic intensity level (TIL) score.

RESULTS

The median CPPopt yield was 80.7% (interquartile range 70.9-87.4%). None of the selected variables showed a significant statistical correlation with the CPPopt yield.

CONCLUSION

In this retrospective multicenter study, none of the selected admission and treatment variables were related to the CPPopt yield.

摘要

背景

“最佳”脑灌注压（CPPopt）概念基于血管压力反应性指数（PRx）。目前正在 COGiTATE 试验中前瞻性研究 CPPopt 指导治疗对严重创伤性脑损伤（TBI）患者的可行性和有效性。目前尚无明确证据表明某些入院和治疗特征与 CPPopt 的可用性（产量）相关。

目的

检验患者入院和治疗特征与 CPPopt 平均产量之间的关系。

方法

对使用脑室内探头测量颅内压（ICP）的 230 名 CENTER-TBI 高分辨率数据库患者进行回顾性分析。使用为 COGiTATE 研究设定的算法计算 CPPopt。CPPopt 产量定义为 CPPopt 可用时 CPP 监测时间的百分比（%）。统计模型中的变量包括年龄、入院时格拉斯哥昏迷量表（GCS）评分、性别、瞳孔反应、现场缺氧和低血压、马歇尔计算机断层扫描（CT）评分、去骨瓣减压术、损伤严重程度评分和 24 小时治疗强度评分（TIL）。