Evidence map›Paper›PMID 40727013›Full record

ArticleEClinicalMedicine2025

Dynamic versus fixed cerebral perfusion pressure targets in paediatric traumatic brain injury: a STARSHIP analysis.

C A Smith, S Y Bögli, M M Placek, M Cabeleira, D White, E Daubney, A Young, E Beqiri, R Kayani, R O'Donnell and 18 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing 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

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

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

3 citing papers in PubMed.

  1. Observational
  2. Observational
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

C A SmithDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
S Y BögliDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
M M PlacekDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
M CabeleiraDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
D WhiteDepartment of Paediatrics, University of Cambridge, Cambridge, UK.
E DaubneyDepartment of Paediatrics, University of Cambridge, Cambridge, UK.
A YoungDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
E BeqiriDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
R KayaniPaediatric Intensive Care, Cambridge University Hospitals, Cambridge, UK.
R O'DonnellPaediatric Intensive Care, Cambridge University Hospitals, Cambridge, UK.
N PathanDepartment of Paediatrics, University of Cambridge, Cambridge, UK.
S WatsonPaediatric Neuropsychology, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.
A MawDepartment of Paediatrics, University of Cambridge, Cambridge, UK.
M GarnettDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
H K KanthimathinathanPaediatric Intensive Care, Birmingham Children's Hospital, Birmingham, UK.
H BangalorePaediatric Intensive Care, Great Ormond Street Hospital, London, UK.
S SundararajanPaediatric Intensive Care, Leeds Children's Hospital, Leeds, UK.
G SubramanianPaediatric Intensive Care, Manchester Children's Hospital, Manchester, UK.
D RaffajPaediatric Intensive Care, Nottingham Children's Hospital, Nottingham, UK.
S LamparielloPaediatric Intensive Care, Oxford University Hospitals, Oxford, UK.
A SarfattiPaediatric Intensive Care, Royal London Hospital, London, UK.
A MayerPaediatric Intensive Care, Sheffield Children's Hospital, Sheffield, UK.
O RossPaediatric Intensive Care, Southampton General Hospital, Southampton, UK.
M CzosnykaDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
P J HutchinsonDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
P SmielewskiDepartment of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
S AgrawalDepartment of Paediatrics, University of Cambridge, Cambridge, UK.
STARSHIP Study Team

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Cerebral perfusion pressure (CPP) represents a key target for intensive care management of paediatric traumatic brain injury (TBI) patients. Current guidelines recommend a CPP target within the range of 40-50 mmHg but emphasise that these may depend on patient age and the state of cerebrovascular autoregulation. In this analysis, we aimed to compare the fixed targets proposed by the Brain Trauma Foundation to autoregulation-based targets CPPopt (optimal CPP) and LLA (Lower Limit of Autoregulation). Methods: Data were acquired from the STARSHIP study (a prospective, multicentre, observational, research study which enrolled 135 children (median age 96 months (interquartile range 26-152 months)) with TBI between July 2018 and March 2023 across 10 paediatric intensive care units in the UK). In this secondary analysis the dose or percentage time spent below a fixed CPP target of 50 mmHg or CPPopt or LLA (assessed continuously on a minute-by-minute basis and derived by fitting a curve to the relationship between CPP and pressure reactivity index values, as previously described) was compared by outcome using univariable and multivariable methods. ClinicalTrials.gov registration-NCT0688462. Findings: When assessed within ordinal analyses (to account for differences in baseline severity), both hourly dose and percentage time spent below LLA (odds ratio 1.01 [95% CI 1.00-1.02], p = 0.017 and 1.05 [95% CI 1.01-1.08], p = 0.008 respectively) were independently associated with worse outcomes. LLA displayed a dynamic time-trend increasing over time in patients with unfavourable outcome (n = 44, p = 0.003). Overall, LLA exceeded 50 mmHg for more than 45% of the monitoring period across all patients, and for over 35% of the time in the youngest cohort (0-2 years). Interpretation: Dynamic autoregulation monitoring based on LLA was associated with outcomes in paediatric TBI with higher LLA values observed in individuals experiencing unfavourable outcomes. Our findings indicate that the current fixed CPP threshold of 40-50 mmHg may be too low-highlighting the need for further investigation into autoregulation-guided CPP targets. Whether personalised management based on autoregulatory-informed thresholds offers advantages over guideline-based targets remains to be determined and should be investigated in future prospective interventional studies. Funding: Action Medical Research for Childrens' Charity and Addenbrookes Charitable Trust (UK Grant number-GN2609).

Indexed as

Cerebral perfusion pressureCerebrovascular autoregulationIntensive care managementMultimodality neuromonitoringPaediatric traumatic brain injury

Identifiers

PMID40727013
PMCPMC12303001

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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.