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Effect of continuous display of cerebral perfusion pressure on outcomes in patients with traumatic brain injury.

BACKGROUND: Clinical bedside monitoring systems do not provide prominent displays of data on cerebral perfusion pressure (CPP). Immediate visual feedback would allow more rapid intervention to prevent or minimize suboptimal pressures. OBJECTIVE: To evaluate the effect of a highly visible CPP display...

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Published in:American Journal of Critical Care Vol. 15; no. 6; pp. 600 - 611
Main Authors: Kirkness CJ, Burr RL, Cain KC, Newell DW, Mitchell PH
Format: CEU clinical trial exam questions pictorial research tables/charts Journal Article
Published: American Association of Critical-Care Nurses Nov2006
Online Access:View this record in EBSCOhost
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        10623264
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      jtl: American Journal of Critical Care
      issn: 10623264
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    pubinfo:
      dt: Nov2006
      vid: 15
      iid: 6
      pid: 2559
      pub: American Association of Critical-Care Nurses
      place: Alisa Veijo, California
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        10.4037/ajcc2006.15.6.600
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        atl: Effect of continuous display of cerebral perfusion pressure on outcomes in patients with traumatic brain injury.
      aug:
        au:
          Kirkness CJ
          Burr RL
          Cain KC
          Newell DW
          Mitchell PH
        affil: Room T617, Biobehavioral Nursing and Health Systems, 1959 Pacific NE, St, Box 357266, University of Washington, Seattle, WA 98195-7266; kirkness@u.washington.edu
      sug:
        subj:
          Brain Injuries
          Data Display
          Monitoring, Physiologic Methods
          Outcomes (Health Care)
          Tissue Perfusion Evaluation
          Adult
          Algorithms
          Arterial Pressure Evaluation
          Chi Square Test
          Clinical Assessment Tools
          Clinical Trials
          Computer Terminals
          Confidence Intervals
          Convenience Sample
          Critical Care
          Critically Ill Patients
          Data Analysis Software
          Descriptive Statistics
          Education, Continuing (Credit)
          Effect Size
          Female
          Functional Assessment
          Funding Source
          Intensive Care Units
          Logistic Regression
          Male
          Monitoring, Intracranial Pressure
          Outcomes (Health Care) Evaluation
          Random Assignment
          Sample Size Determination
          Severity of Illness Indices
          Survival
          T-Tests
          Human
          Adult: 19-44 years
          Female
          Male
      ab: BACKGROUND: Clinical bedside monitoring systems do not provide prominent displays of data on cerebral perfusion pressure (CPP). Immediate visual feedback would allow more rapid intervention to prevent or minimize suboptimal pressures. OBJECTIVE: To evaluate the effect of a highly visible CPP display on immediate and long-term functional outcome in patients with traumatic brain injury. METHODS: A total of 157 patients with traumatic brain injury at a level 1 trauma center who had invasive arterial blood pressure and intracranial pressure monitoring were randomized to beds with or without an additional, prominent continuous CPP display. Primary end points were scores on the Extended Glasgow Outcome Scale (GOSE) and Functional Status Examination (FSE) 6 months after injury. Secondary end points were GOSE scores at discharge and 3 months after injury and FSE score 3 months after injury. RESULTS: Although GOSE and FSE scores at 6 months were better in the group with the highly visible CPP display, the differences were not significant. Slope of recovery for GOSE and FSE over all follow-up time points did not differ significantly between groups. However, the intervention's positive effect on odds of survival at hospital discharge was strong and significant. Within a subgroup of more severely injured patients, the intervention group was much less likely than the control group to have CPP deviations. CONCLUSIONS: The presence of a highly visible display of CPP was associated with significantly better odds of survival and overall condition at discharge.
      pubtype: Academic Journal
      doctype:
        CEU
        clinical trial
        exam questions
        pictorial
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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