Evidence map›Paper›PMID 39009939›Full record

ArticleNeurocritical care2025

Intracranial Pressure Thresholds for Cerebral Autoregulation Impairment: Age-Stratified Analysis of Ultra-Low-Frequency Pressure Reactivity Index (UL-PRx) in Traumatic Brain Injury.

Marco Bonfanti, Ferdinando Luca Lorini, Rosalia Zangari, Ezio Bonanomi, Alessia Farina, Giulio Pezzetti, Simonetta Gerevini, Silvia Aresi, Giacomo Dell'Avanzo, Fabio Micheli and 3 more

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Article in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Observational
4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Marco BonfantiFROM Research Foundation- ETS, Papa Giovanni XXIII Hospital, Piazza OSM 1, 24129, Bergamo, Italy. m.bonfanti07@gmail.com.ORCID 0009-0003-1164-9518
Ferdinando Luca LoriniDepartment of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Rosalia ZangariFROM Research Foundation- ETS, Papa Giovanni XXIII Hospital, Piazza OSM 1, 24129, Bergamo, Italy.
Ezio BonanomiDepartment of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Alessia FarinaDepartment of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Giulio PezzettiDepartment of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Simonetta GereviniDepartment of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Silvia AresiDepartment of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Giacomo Dell'AvanzoDepartment of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Fabio MicheliDepartment of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Luigi Andrea LanternaDepartment of Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Francesco BiroliFROM Research Foundation- ETS, Papa Giovanni XXIII Hospital, Piazza OSM 1, 24129, Bergamo, Italy.
Paolo GrittiDepartment of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe study investigated the effectiveness of low-frequency sampling in detecting alterations in cerebrovascular reactivity (CVR) associated with changes in intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across different age groups. The primary objective was to investigate an ICP threshold that indicates a decrease in CVR as evidenced by a significant increase in the ultra-low-frequency pressure reactivity index (UL-PRx). Additionally, the study aimed to develop an age-based categorization method for patients with TBI to investigate the differences between these ICP thresholds in different age groups.

methodsIn this retrospective analysis, data from 263 patients with TBI were prospectively collected. ICP and mean arterial pressure were extracted from the hospital database at 5-min intervals. Demographic details, clinical presentation, computed tomography scans, neurosurgical interventions, and 12-months outcome were recorded. ICP versus UL-PRx values were categorized into ICP bins and graphically represented with boxplots for each age group, illustrating how as ICP values rise, there is a bin (age-tailored ICP [AT-ICP]) beyond which UL-PRx shows a sudden increase, indicating CVR loss. Homogeneous age groups were established to obtain a consistent AT-ICP threshold. The discriminatory ability of the AT-ICP thresholds was compared with the guideline-recommended thresholds by calculating the area under the Receiver Operating Characteristic curve of the ICP-derived indices (dose above threshold, and the hourly dosage above threshold).

resultsAge groups 0-5, 6-20, 21-60, 61-70, and 71-85 years were the best age subdivisions, corresponding to AT-ICP thresholds of 20, 30, 35, 25, and 30 mmHg, respectively. The AT-ICP thresholds exhibited better discriminative ability compared with the guideline-recommended thresholds.

conclusionsThe AT-ICP thresholds offer a novel approach for estimating CVR impairment and the developed method represents an alternative solution to address the age stratification issue in patients with TBI.

Indexed as

Brain Injuries, TraumaticCerebrovascular CirculationHomeostasisIntracranial PressureNeurophysiological MonitoringAdolescentAdultAgedAged, 80 and overAge FactorsArterial PressureChildChild, PreschoolFemaleHumansMaleAge groupsCerebrovascular reactivityIntracranial pressureThresholdTraumatic brain injuryUltra-low-frequency pressure reactivity index

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.