ArticleCritical care (London, England)2023
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.
Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
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Who cites it
38 citing papers in PubMed.
- Stable tissue oxygen cerebral perfusion pressure (stoCPP): Proof of concept for a novel method for the assessment of optimum cerebral perfusion pressure in severe traumatic brain injury.Journal of clinical monitoring and computing · 2026Article
- Individualising Neurointensive Care of Traumatic Brain Injury: Reduced Signal Complexity Relates to Secondary Insults and Predicts Worse Outcome.Neurocritical care · 2026Article
- Prognostic Value of Cerebrovascular Reactivity (PRx) Versus Intracranial Pressure (ICP) Monitoring in Traumatic Brain Injury: Systematic Review.Journal of clinical medicine · 2026Review
- Proteomic blood-based biomarkers of brain damage in traumatic brain injury: are they suitable surrogate endpoints for cerebral pressure autoregulatory-guided therapy?Critical care (London, England) · 2026Observational
- Temporal dynamics of ICP, PRx, CPP, and CPPopt in relation to functional outcome in spontaneous cerebellar hemorrhage.Critical care (London, England) · 2026Article
- Intracranial Pressure Monitoring, Heart Rate Variability, Baroreflex Sensitivity, and Signal Complexity During Neurointensive Care after Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction.Neurocritical care · 2026Article
- Temporal Dynamics of Cerebral Autoregulation after Aneurysmal Subarachnoid Hemorrhage: Insights from Pressure Reactivity Index and Non-injured Controls.Neurology and therapy · 2026Article
- Exploring the Upper Limits of Cerebral Perfusion Pressure in Pediatric Traumatic Brain Injury: A STARSHIP Analysis.Neurocritical care · 2026Observational
- Cerebral perfusion pressure trajectories and cumulative exposure metrics predict in-hospital mortality in acute brain injury.Frontiers in medicine · 2026Article
- Editorial: Advances in neurocritical care.Frontiers in medicine · 2026Article
- Ventricular septum curvature ratio: a novel imaging marker to predict clinical deterioration in normotensive acute pulmonary embolism.Critical care (London, England) · 2025Article
- The lower limit margin: a determinant of autoregulatory sensitivity to changes in cerebral perfusion pressure.Critical care (London, England) · 2025Article
- Visualizations of autoregulatory insults in moderate-to-severe paediatric traumatic brain injury: a secondary analysis from the multicentre STARSHIP trial.Critical care (London, England) · 2025Article
- Dynamic versus fixed cerebral perfusion pressure targets in paediatric traumatic brain injury: a STARSHIP analysis.EClinicalMedicine · 2025Article
- Predicting Deterioration in Patients With Normotensive Acute Pulmonary Embolism Using Clinical-Imaging Features: A Multicenter Prospective Cohort Study.Journal of the American Heart Association · 2025Observational
- Monro-Kellie 4.0: moving from intracranial pressure to intracranial dynamics.Critical care (London, England) · 2025Review
- Impaired Cerebral Autoregulation in Children.Pediatric neurology · 2025Review
- Cerebral perfusion pressure targets after traumatic brain injury: a reappraisal.Critical care (London, England) · 2025Observational
- Intracranial pressure dynamics, cerebral autoregulation, and brain perfusion after decompressive craniectomy in malignant middle cerebral artery infarction: is there a role for invasive monitoring?Acta neurochirurgica · 2025Article
- Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: lessons and insights from cases, events, and patterns.Critical care (London, England) · 2025Review
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13 authors.
Funding
Abstract
backgroundA previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort.
methodsRecordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal-Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong's test.
resultsAverage LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP.
conclusionsUsing a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.
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