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- W2998223175 abstract "Patient-specific management methodology is crucial for outcomes of patients with traumatic brain injury (TBI). The clinical outcomes depend on cerebrovascular autoregulation (CA) impairments which can also be affected by patients’ age, brain injury grade or pharmacological influences. Here we compare the effectiveness of optimal cerebral perfusion pressure (CPPopt) targeted therapy in younger (<45 years-old) and elderly (≥45 years-old) TBI patients. Multimodal invasive ABP(t), ICP(t), CPP(t), and CPPopt(t) monitoring was performed on 81 severe TBI patients in Republic Vilnius University Hospital (Lithuania). ICM+ software was used for continuous CPPopt(t) assessment by identification of Pressure Reactivity Index (PRx(t)). The analysis of associations between the patients' outcome and complex of monitored physiological parameters was performed by creating multifactorial model of TBI patient’s outcome prediction. The most significant prognostic factors were age, GCS, serum glucose, Helsinki CT score and duration of Longest CA Impairment event (LCAI) when PRx(t) > 0.5 within 24 h after admission. The modeled accuracies for mortality and unfavorable outcome prediction were 82% and 86%, respectively. Age > 45 years was associated with unfavorable outcome. CPP values close to CPPopt were associated with a better outcome in younger patients. Mean ΔCPPopt < −5.0 mmHg, mean PRx > 0.36, and LCAI > 100 min were significantly associated with mortality for the younger patients. The critical values of averaged PRx > 0.26 and LCAI > 61 min were significantly associated with mortality for the elderly group. Autoregulation guided treatment was more effective for individual TBI management in younger patients. A phase III study is needed to prove an effectiveness of CPPopt targeted therapy for elderly patient." @default.
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- W2998223175 date "2019-10-01" @default.
- W2998223175 modified "2023-10-14" @default.
- W2998223175 title "Patient specific TBI patients’ treatment: single center study" @default.
- W2998223175 doi "https://doi.org/10.1016/j.jns.2019.10.466" @default.
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