Volume 19 Supplement 1

35th International Symposium on Intensive Care and Emergency Medicine

Open Access

One-size-fits-all or patient-tailored hemodynamic targets in post-cardiac arrest patients: an observational near-infrared spectroscopy study on cerebral autoregulation

  • C Genbrugge1,
  • K Ameloot1,
  • I Meex1,
  • W Boer1,
  • F Jans1,
  • W Mullens1,
  • M Dupont1,
  • B Ferdinande1,
  • J Dens1 and
  • C Dedeyne1
Critical Care201519(Suppl 1):P432

https://doi.org/10.1186/cc14512

Published: 16 March 2015

Introduction

A subgroup of post-CA patients with disturbed cerebral autoregulation might benefit from higher mean arterial pressures (MAPs). We aimed to (1) investigate whether patients with disturbed autoregulation have a worse prognosis, (2) phenotype these patients, (3) define an individual optimal MAP and (4) investigate whether time under this individual optimal MAP is associated with outcome.

Methods

A prospective observational study in 51 post-CA patients monitored with near-infrared spectroscopy.

Results

(1) In multivariate analysis, patients with preserved autoregulation (33.65%) had a significant higher 180-day survival rate (OR = 4.62, 95% CI (1.06; 20.06), P = 0.04). (2) Phenotypically, a higher proportion of patients with disturbed autoregulation had pre-CA hypertension (31 ± 47 vs. 65 ± 49%, P = 0.02) suggesting that right shifting of autoregulation is caused by chronic adaptation of cerebral blood flow to higher blood pressures. Based on an index of autoregulation (COX), the average COX-predicted optimal MAP was 85 mmHg in patients with preserved and 100 mmHg in patients with disturbed autoregulation. (3) An individual optimal MAP could be determined in 33/51 patients. (4) The time under the individual optimal MAP was negatively associated with survival (OR = 0.97, 95% CI (0.96; 0.99), P = 0.02). The time under previously proposed fixed targets (65, 70, 75, 80 mmHg) was not associated with a differential survival rate.

Conclusion

Cerebral autoregulation was shown to be disturbed in 35% of post-CA patients of which a majority had pre-CA hypertension. Disturbed cerebral autoregulation within the first 24 hours after CA is associated with a worse outcome. In contrast to uniform MAP goals, the time spent under a patient-tailored optimal MAP, based on an index of autoregulation, was negatively associated with survival.

Authors’ Affiliations

(1)
ZOL Genk

Copyright

© Genbrugge et al.; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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