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Open Access Research article

Cerebral perfusion pressure, microdialysis biochemistry and clinical outcome in patients with traumatic brain injury

Theoniki Paraforou1, Konstantinos Paterakis2, Konstantinos Fountas26, George Paraforos1, Achilleas Chovas1, Anastasia Tasiou3, Maria Mpakopoulou3, Dimitrios Papadopoulos4, Antonios Karavellis5 and Apostolos Komnos16*

Author Affiliations

1 General Hospital of Larissa, Larissa, Greece

2 Assistant Professor, Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece

3 Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece

4 General Hospital of Larissa, Larissa, Greece

5 Professor Εmeritus, Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece

6 Institute of Biomedical Research and Technology (BIOMED)/CERETETH, 51 Papanastasiou Str, 41222 Larissa, Greece

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BMC Research Notes 2011, 4:540  doi:10.1186/1756-0500-4-540

Published: 14 December 2011

Abstract

Background

Traumatic Brain Injury (TBI) is a major cause of death and disability. It has been postulated that brain metabolic status, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) are related to patients' outcome. The aim of this study was to investigate the relationship between CPP, ICP and microdialysis parameters and clinical outcome in TBIs.

Results

Thirty four individuals with severe brain injury hospitalized in an intensive care unit participated in this study. Microdialysis data were collected, along with ICP and CPP values. Glasgow Outcome Scale (GOS) was used to evaluate patient outcome at 6 months after injury. Fifteen patients with a CPP greater than 75 mmHg, L/P ratio lower than 37 and Glycerol concentration lower than 72 mmol/l had an excellent outcome (GOS 4 or 5), as opposed to the remaining 19 patients. No patient with a favorable outcome had a CPP lower than 75 mmHg or Glycerol concentration and L/P ratio greater than 72 mmol/l and 37 respectively. Data regarding L/P ratio and Glycerol concentration were statistically significant at p = 0.05 when patients with favorable and unfavorable outcome were compared. In a logistic regression model adjusted for age, sex and Glasgow Coma Scale on admission, a CPP greater than 75 mmHg was marginally statistically significantly related to outcome at 6 months after injury.

Conclusions

Patients with favorable outcome had certain common features in terms of microdialysis parameters and CPP values. An individualized approach regarding CPP levels and cut -off points for Glycerol concentration and L/P ratio are proposed.

Keywords:
Traumatic brain injury; Microdialysis; Cerebral perfusion pressure; Outcome; Intensive care unit