OBJECTIVE Different paradigms for neurocritical care of traumatic brain injury (TBI) have emerged in conjunction with advanced neuromonitoring technologies and derived metrics. The priority for optimizing these metrics is not currently clear. The goal of this study was to determine whether achieving cerebral perfusion pressure (CPPopt) also improves other metrics like brain oxygenation and brain blood flow. METHODS The authors performed a retrospective analysis of high-frequency data from patients with TBI who were treated at a single center and who had partial pressure of brain oxygen (PbtO2) measurements and/or brain blood flow measurements, while also undergoing intracranial pressure (ICP) monitoring. CPPopt was not calculated or targeted during patient care, but was retrospectively computed, as was the difference between the observed CPP and CPPopt. RESULTS A total of 22 patients with ICP, PbtO2, and/or brain blood flow monitoring were included in the analysis, and 245.7 days of measurements obtained every second were analyzed including 6,748,866 PbtO2 measurements, 3,296,405 blood flow measurements, and 10,264,770 ICP measurements. The data obtained every second were averaged by minute for analysis. In summative data, PbtO2 measurements peaked near CPPopt and were not improved above CPPopt. Blood flow measurements remained stable near CPPopt, decreased below it, and increased when CPP exceeded CPPopt. ICP decreased linearly with CPP without a specific relationship with CPPopt. In an inverse analysis, the percentage of CPP values at CPPopt, although significantly higher on the favorable side of contemporary treatment thresholds of PbtO2, ICP, and blood flow, was not found to be strongly correlated with the mean values of the physiological measurements obtained every minute (r = 0.27, r = 0.11, and r = 0.47 for ICP, PbtO2, and blood flow, respectively; p < 0.0001). CONCLUSIONS Although CPPopt was not targeted in the patients in this study, CPPopt was a physiologically significant value based on concurrent measurements of PbtO2 and blood flow. In summative data, achievement of CPPopt was associated with optimized PbtO2 and blood flow. Conversely, the correlation between achievement of CPPopt and the mean measurement value was not strong, strengthening the significance of CPPopt. In individual patients, achieving CPPopt is not always associated with optimal PbtO2 or blood flow. Further research should explore these relationships in treatment paradigms that specifically target CPPopt. These data do not support the premise that targeting and achieving CPPopt obviates the need for concurrent PbtO2 and blood flow monitoring. Although these data suggest that targeting CPPopt may be an appropriate initial treatment strategy, they do not provide evidence that CPPopt should be targeted with highest priority.

中文翻译：

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与最佳脑灌注压相关的局部脑氧、血流量和颅内压测量。

目的 结合先进的神经监测技术和衍生指标，出现了针对创伤性脑损伤 (TBI) 的神经重症监护的不同范式。目前尚不清楚优化这些指标的优先顺序。本研究的目的是确定达到脑灌注压 (CPPopt) 是否也会改善其他指标，如脑氧合和脑血流量。方法 作者对在单一中心接受治疗的 TBI 患者的高频数据进行了回顾性分析，这些患者进行了脑氧分压 (PbtO2) 测量和/或脑血流测量，同时还进行了颅内压 (ICP) 测量。 ）监控。CPPopt 在患者护理期间并未计算或确定目标，而是进行回顾性计算，观察到的 CPP 与 CPPopt 之间的差异也是如此。结果 共有 22 名进行 ICP、PbtO2 和/或脑血流监测的患者纳入分析，分析了每秒获得的 245.7 天的测量结果，其中包括 6,748,866 次 PbtO2 测量、3,296,405 次血流测量和 10,264,770 次 ICP 测量。将每秒获得的数据按分钟进行平均以进行分析。在总结数据中，PbtO2 测量值在 CPPopt 附近达到峰值，并且没有改善到高于 CPPopt。血流测量值在 CPPopt 附近保持稳定，低于 CPPopt 时下降，当 CPP 超过 CPPopt 时则增加。ICP 随 CPP 线性下降，与 CPPopt 没有特定关系。在逆向分析中，CPPopt 处的 CPP 值百分比虽然显着高于 PbtO2、ICP 和血流的当代治疗阈值的有利一侧，但并未发现与每次获得的生理测量平均值有很强的相关性。分钟（ICP、PbtO2 和血流量分别为 r = 0.27、r = 0.11 和 r = 0.47；p < 0.0001）。结论 虽然 CPPopt 不是本研究中患者的目标，但基于 PbtO2 和血流量的同时测量，CPPopt 是一个具有生理意义的值。在总结性数据中，CPPopt 的实现与优化的 PbtO2 和血流相关。相反，CPPopt 的成绩与平均测量值之间的相关性不强，增强了 CPPopt 的显着性。在个别患者中，实现 CPPopt 并不总是与最佳 PbtO2 或血流相关。进一步的研究应该探索专门针对 CPPopt 的治疗范式中的这些关系。这些数据并不支持以下前提：瞄准并实现 CPPopt 就无需同时进行 PbtO2 和血流监测。尽管这些数据表明以 CPPopt 为目标可能是一种合适的初始治疗策略，但它们并没有提供证据表明 CPPopt 应作为最高优先级的目标。