Artikel
Continuous monitoring of cerebrovascular pressure reactivity for individual optimisation of cerebral perfusion pressure after head injury: A validation study
Kontinuierliches Monitoring der zerebrovaskulären Druckreaktivität zur individuellen Optimierung des zerebralen Perfusionsdruckes nach schwerem Schädel-Hirn-Trauma: Validierung eines pathophysiologischen Konzeptes
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Autoren
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M. Jaeger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
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M. Schuhmann
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
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J. Meixensberger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
| Veröffentlicht: | 11. April 2007 |
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Gliederung
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Objective: The optimal level of cerebral perfusion pressure after head injury is still under debate. It appears questionable, whether current CPP regimes, treating all patients and using the same blanket protocol, sufficiently meet the individual patient’s pathophysiological requirements. A concept for the determination of an individually optimised CPP (CPPopt) is based on the continuous monitoring of the index of cerebrovascular pressure reactivity, PRx (Steiner et al., Crit Care Med 2002). The aim of our study was to investigate the relationship between the PRx-derived CPPopt and the partial pressure of brain tissue oxygen (PtiO2).
Methods: Following severe head injury continuous monitoring of mean arterial pressure (MAP), intracranial pressure (ICP), CPP, and PtiO2 was performed in 29 patients. PRx was calculated as the moving correlation coefficient between MAP and ICP. CPPopt was calculated according to the criteria set by Steiner at al., as the CPP-level at which PRx reached its lowest value.
Results: A CPPopt could be identified in 26 of 29 patients. CPPopt ranged from 60-65mmHg to 90-95mmHg. Below the level of CPPopt, the PtiO2 increased parallel to increasing CPP. In contrast, at CPP levels above CPPopt, no further increase in PtiO2 could be attained.
Conclusions: The elevation of CPP above the level of CPPopt does not lead to a further improvement of PtiO2. Thus, the results of our study support the pathophysiological concept of a PRx-based calculation of an individual CPPopt after head injury. The individual CPPopt values show a relatively wide range from 60mmHg to 95mmHg and display the variable needs of patients’ regarding their required CPP level.
