ArticleActa neurochirurgica2019
Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis.
Article in Acta neurochirurgica, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers.
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Who cites it
41 citing papers in PubMed, 80 citations in OpenAlex.
- A Harmonised Protocol for the Use of PRx in Adult and Paediatric TBI Patients with ICP Monitoring: CLINICCA Workgroup Output.Neurocritical care · 2026Article
- A novel algorithm for the continuous determination of individualized intracranial pressure (iICP) thresholds using a multi-window weighted approach.BMC medical informatics and decision making · 2026Article
- Optimal cerebrovascular reactivity thresholds for the determination of individualized intracranial pressure thresholds in traumatic brain injury: a CAHR-TBI cohort study.Critical care (London, England) · 2025Article
- Continuous personalized cerebrovascular reactivity-based physiologic metrics in neurocritical care: a narrative review of the current landscape, limitations, and future directions.Frontiers in physiology · 2025Review
- Optimal bispectral index exists in healthy patients undergoing general anesthesia: A validation study.Journal of clinical monitoring and computing · 2024Article
- Early Cardiac Evaluation, Abnormal Test Results, and Associations with Outcomes in Patients with Acute Brain Injury Admitted to a Neurocritical Care Unit.Journal of clinical medicine · 2024Article
- Exploration of uncertainty of PRx time trends.Brain & spine · 2024Article
- Statistical properties of cerebral near infrared and intracranial pressure-based cerebrovascular reactivity metrics in moderate and severe neural injury: a machine learning and time-series analysis.Intensive care medicine experimental · 2023Article
- The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury.Intensive care medicine experimental · 2023Article
- Towards autoregulation-oriented management after traumatic brain injury: increasing the reliability and stability of the CPPopt algorithm.Journal of clinical monitoring and computing · 2023Article
- Temporal relationship between vasopressor and sedative administration and cerebrovascular response in traumatic brain injury: a time-series analysis.Intensive care medicine experimental · 2023Article
- The lower limit of reactivity as a potential individualised cerebral perfusion pressure target in traumatic brain injury: a CENTER-TBI high-resolution sub-study analysis.Critical care (London, England) · 2023Article
- The utility of therapeutic hypothermia on cerebral autoregulation.Journal of intensive medicine · 2023Review
- Cerebrovascular Pressure Reactivity Measures: Index Comparison and Clinical Outcome in Patients With Traumatic Brain Injury Treated According to an Intracranial Pressure-Focused Management: Rejection of the Null Hypothesis.Neurotrauma reports · 2023Article
- Intracranial Pressure Monitoring and Treatment Thresholds in Acute Neural Injury: A Narrative Review of the Historical Achievements, Current State, and Future Perspectives.Neurotrauma reports · 2023Article
- Cerebrovascular Reactivity Is Not Associated With Therapeutic Intensity in Adult Traumatic Brain Injury: A Validation Study.Neurotrauma reports · 2023Article
- Multimodal and autoregulation monitoring in the neurointensive care unit.Frontiers in neurology · 2023Review
- Current state of high-fidelity multimodal monitoring in traumatic brain injury.Acta neurochirurgica · 2022Review
- Traumatic brain injury: progress and challenges in prevention, clinical care, and research.The Lancet. Neurology · 2022Review
- Optimal bispectral index level of sedation and cerebral oximetry in traumatic brain injury: a non-invasive individualized approach in critical care?Intensive care medicine experimental · 2022Article
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Authors and funding
12 authors at 5 institutions in 5 countries.
Funding
Abstract
backgroundImpaired cerebrovascular reactivity in adult traumatic brain injury (TBI) is known to be associated with poor outcome. However, there has yet to be an analysis of the association between the comprehensively assessed intracranial hypertension therapeutic intensity level (TIL) and cerebrovascular reactivity.
methodsUsing the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived pressure reactivity index (PRx) as the moving correlation coefficient between slow-wave in ICP and mean arterial pressure, updated every minute. Mean daily PRx, and daily % time above PRx of 0 were calculated for the first 7 days of injury and ICU stay. This data was linked with the daily TIL-Intermediate scores, including total and individual treatment sub-scores. Daily mean PRx variable values were compared for each TIL treatment score via mean, standard deviation, and the Mann U test (Bonferroni correction for multiple comparisons). General fixed effects and mixed effects models for total TIL versus PRx were created to display the relation between TIL and cerebrovascular reactivity.
resultsA total of 249 patients with 1230 ICU days of high frequency physiology matched with daily TIL, were assessed. Total TIL was unrelated to daily PRx. Most TIL sub-scores failed to display a significant relationship with the PRx variables. Mild hyperventilation (p < 0.0001), mild hypothermia (p = 0.0001), high levels of sedation for ICP control (p = 0.0001), and use vasopressors for CPP management (p < 0.0001) were found to be associated with only a modest decrease in mean daily PRx or % time with PRx above 0.
conclusionsCerebrovascular reactivity remains relatively independent of intracranial hypertension therapeutic intensity, suggesting inadequacy of current TBI therapies in modulating impaired autoregulation. These findings support the need for investigation into the molecular mechanisms involved, or individualized physiologic targets (ICP, CPP, or Co2) in order to treat dysautoregulation actively.
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