• Erta Beqiri, Jeanette Tas, Marek Czosnyka, Ruud C R van Kaam, Joseph Donnelly, Roel H Haeren, van der HorstIwan C CICC0000-0003-3891-8522Department of Intensive Care Medicine, University Maastricht, Maastricht University Center Maastricht, Maastricht, The Netherlands.Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Peter J Hutchinson, van KuijkSander M JSMJ0000-0003-2796-729XDepartment of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands., Annalisa L Liberti, David K Menon, HoedemaekersCornelia W ECWEDepartment of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands., Bart Depreitere, Geert Meyfroidt, Ari Ercole, AriesMarcel J HMJH0000-0002-2155-688XDepartment of Intensive Care Medicine, University Maastricht, Maastricht University Center Maastricht, Maastricht, The Netherlands.School for Mental Health and Neuroscience, University Maastricht, Maastricht, The Nethe, and Peter Smielewski.
• Brain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK. vb391@cam.ac.uk.
• Neurocrit Care. 2024 Dec 2.

BackgroundThe 'CPPopt-Guided Therapy: Assessment of Target Effectiveness' (COGiTATE) randomised controlled trial demonstrated the feasibility and safety of targeting an automated cerebral perfusion pressure (CPP) tailored to optimize cerebrovascular autoregulation (CPPopt) in patients with traumatic brain injury (TBI) requiring intracranial pressure management. The average values of the autoregulation index known as the pressure reactivity index (PRx) were not different between the intervention (CPP target = CPPopt) and control (CPP target = 60-70 mmHg) groups of the trial. This secondary analysis was performed to investigate whether: (1) in the intervention group, PRx was closer to PRxopt (PRx at CPPopt) values, indicating a more preserved reactivity, as opposed to in the control group; (2) in the intervention group, patients experienced lower hourly PRx when CPP was close to the CPPopt-based target.MethodsWe analyzed data from the 28 and 32 patients randomized to the control and intervention groups of the COGiTATE study, respectively. We compared hourly averaged ΔPRx (PRx minus PRxopt, where PRxopt is PRx at CPPopt) between the two groups, focusing on periods of globally preserved/homogeneous autoregulation (negative PRxopt). For each patient in the intervention group, PRx values in periods when ΔCPP (CPP minus CPPopt target) was between -5 and + 5 mm Hg were compared to values in periods when ΔCPP was outside this range.ResultsThe median ΔPRx was significantly lower in the intervention group for negative PRxopt (Mann-Whitney U-test, p < 0.001). For each patient in this group, the median PRx was lower in periods when CPP was close to the CPPopt-based target (Wilcoxon test, p < 0.001).ConclusionsDespite no statistically significant difference in the grand mean PRx, our results suggest that targeting CPPopt does provide a way of improving cerebrovascular reactivity in patients with TBI, offering a rational intervention for trials that address this issue. We also bring insight into aspects of the PRx/CPP relationship that should be considered for autoregulation-guided management for future clinical protocols and trials design.© 2024. The Author(s).

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