<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Introduction</h3>
<p>Management of traumatic brain injury (TBI) has to counterbalance prevention of secondary brain injury without systemic complications, namely lung injury. The potential risk of developing acute respiratory distress syndrome (ARDS) leads to therapeutic decisions such as fluid balance restriction, high PEEP and other lung protective measures, that may conflict with neurologic outcome. In fact, low cerebral perfusion pressure (CPP) may induce secondary ischemic injury and mortality, but disproportionate high CPP may also increase morbidity and worse lung compliance and hypoxia with the risk of developing ARDS and fatal outcome. The evaluation of cerebral autoregulation at bedside and individualized (optimal CPP) CPPopt-guided therapy, may not only be a relevant measure to protect the brain, but also a safe measure to avoid systemic complications.</p>
</sec>
<sec>
<h3>Aim of the study</h3>
<p>We aimed to study the safety of CPPopt-guided-therapy and the risk of secondary lung injury association with bad outcome.</p>
</sec>
<sec>
<h3>Methods and results</h3>
<p>Single-center retrospective analysis of 92 severe TBI patients admitted to the Neurocritical Care Unit managed with CPPopt-guided-therapy by PRx (pressure reactivity index). During the first 10 days, we collected data from blood gas, ventilation and brain variables. Evolution along time was analyzed using linear mixed-effects regression models. 86% were male with mean age 53±21 years. 49% presented multiple trauma and 21% thoracic trauma. At hospital admission, median GCS was 7 and after 3-months GOS was 3. Monitoring data was CPP 86±7mmHg, CPP-CPPopt -2.8±10.2mmHg and PRx 0.03±0.19. The average PFratio (PaO<sub>2</sub>/FiO<sub>2</sub>) was 305±88 and driving pressure 15.9±3.5cmH<sub>2</sub>O. PFratio exhibited a significant quadratic dependence across time and PRx and driving pressure presented significant negative association with PFRatio. CPP and CPPopt did not present significant effect on PFratio (p=0.533; p=0.556). A significant positive association between outcome and the difference CPP-CPPopt was found.</p>
</sec>
<sec>
<h3>Conclusion</h3>
<p>Management of TBI using CPPopt-guided-therapy was associated with better outcome and seems to be safe regarding the development of secondary lung injury.</p>
</sec>
</abstract>

Introduction
Management of traumatic brain injury (TBI) has to counterbalance prevention of secondary brain injury without systemic complications, namely lung injury. The potential risk of developing acute respiratory distress syndrome (ARDS) leads to therapeutic decisions such as fluid balance restriction, high PEEP and other lung protective measures, that may conflict with neurologic outcome. In fact, low cerebral perfusion pressure (CPP) may induce secondary ischemic injury and mortality, but disproportionate high CPP may also increase morbidity and worse lung compliance and hypoxia with the risk of developing ARDS and fatal outcome. The evaluation of cerebral autoregulation at bedside and individualized (optimal CPP) CPPopt-guided therapy, may not only be a relevant measure to protect the brain, but also a safe measure to avoid systemic complications.


Aim of the study
We aimed to study the safety of CPPopt-guided-therapy and the risk of secondary lung injury association with bad outcome.


Methods and results
Single-center retrospective analysis of 92 severe TBI patients admitted to the Neurocritical Care Unit managed with CPPopt-guided-therapy by PRx (pressure reactivity index). During the first 10 days, we collected data from blood gas, ventilation and brain variables. Evolution along time was analyzed using linear mixed-effects regression models. 86% were male with mean age 53±21 years. 49% presented multiple trauma and 21% thoracic trauma. At hospital admission, median GCS was 7 and after 3-months GOS was 3. Monitoring data was CPP 86±7mmHg, CPP-CPPopt -2.8±10.2mmHg and PRx 0.03±0.19. The average PFratio (PaO2/FiO2) was 305±88 and driving pressure 15.9±3.5cmH2O. PFratio exhibited a significant quadratic dependence across time and PRx and driving pressure presented significant negative association with PFRatio. CPP and CPPopt did not present significant effect on PFratio (p=0.533; p=0.556). A significant positive association between outcome and the difference CPP-CPPopt was found.


Conclusion
Management of TBI using CPPopt-guided-therapy was associated with better outcome and seems to be safe regarding the development of secondary lung injury.

Lung Injury Risk in Traumatic Brain Injury Managed With Optimal Cerebral Perfusion Pressure Guided-Therapy

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction
Management of traumatic brain injury (TBI) has to counterbalance prevention of secondary brain injury without systemic complications, namely lung...

Lung Injury Risk in Traumatic Brain Injury Managed With Optimal Cerebral Perfusion Pressure Guided-Therapy

Article Category: Research Article

Published Online: May 08, 2023

Page range: 97 - 105

Received: Aug 11, 2022

Accepted: Jan 31, 2023

DOI: https://doi.org/10.2478/jccm-2023-0009

Keywords
traumatic brain injury, acute lung injury, autoregulation, optimal cerebral perfusion pressure, pressure reactivity index, driving pressure, ARDS

© 2023 Celeste Dias et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Lung Injury Risk in Traumatic Brain Injury Managed With Optimal Cerebral Perfusion Pressure Guided-Therapy

Article Category: Research Article

Published Online: May 08, 2023

Page range: 97 - 105

Received: Aug 11, 2022

Accepted: Jan 31, 2023

DOI: https://doi.org/10.2478/jccm-2023-0009

Keywordstraumatic brain injury, acute lung injury, autoregulation, optimal cerebral perfusion pressure, pressure reactivity index, driving pressure, ARDS

© 2023 Celeste Dias et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
traumatic brain injury, acute lung injury, autoregulation, optimal cerebral perfusion pressure, pressure reactivity index, driving pressure, ARDS