Outcome in adult patients with severe TBI, using a management protocol allowing a cerebral perfusion pressure ≤ 60 mmHg - a retrospective study over 10 years.

backgroundCurrent guidelines for the treatment of severe TBI recommend maintaining a cerebral perfusion pressure (CPP) at 60-70 mmHg. In our institution, as well as others, an alternative algorithm-originally named the Lund concept-has been used. This treatment algorithm employs metoprolol and clonidine to limit CPP, accepting levels below 60 mmHg, with the aim of reducing cerebral edema. Previous reports on this algorithm have shown promising outcome in severe TBI cohorts when compared with many contemporary practices; however, no population-based studies have been conducted to validate these findings. RESEARCH QUESTION: What is the outcome in adult severe TBI using the Lund Concept algorithm in a population-based cohort and how are CPP levels lower than 60 mmHg tolerated?

methodsThe study included 135 evaluable adult patients out of 171 admitted with severe TBI over a ten-year period in the southern Swedish healthcare region. Baseline data, intracranial pressure (ICP), CPP, treatment duration, surgical interventions, and administered drugs were correlated to the Glasgow Outcome Scale Extended (GOSE).

resultsThe 30-day and 6-month mortality rates were 16% and 20%, respectively. A favorable outcome (GOSE 5-8) was achieved in 48% of patients. Only increasing age was associated with inferior outcomes.

conclusionThe use of a management protocol accepting lower CPP levels than those recommended in existing guidelines was generally well tolerated with outcome in line with comparable reports.