A cerebral perfusion pressure (CPP) ≤ 60 mmHg is well tolerated in adult severe traumatic brain injury patients - a retrospective, population-based study

Background Current guidelines for the treatment of severe TBI recommend maintaining a cerebral perfusion pressure (CPP) at 60–70 mmHg. In our institution, as well as others, an alternative algorithm—originally named the Lund concept—has been used. This approach employs metoprolol and clonidine to limit CPP, allowing levels below 60 mmHg, with the aim of reducing cerebral edema. Previous reports on this algorithm have compared favorably to contemporary practices, but no population-based studies have been conducted to validate these findings. Research Question: Are CPP levels lower than 60 mmHg well tolerated in adult patients with severe TBI? Methods The study included all adult patients (n = 135) treated for severe traumatic brain injury (TBI) over a ten-year period in the southern Swedish healthcare region. Baseline data, intracranial pressure (ICP), CPP, treatment duration, surgical interventions, and administered drugs were correlated to the Glasgow Outcome Scale Extended (GOSE). Results The 30-day and 6-month mortality rates were 16% and 20%, respectively. Good outcome (GOSE 7–8) was achieved in 27% of patients. The linear regression analysis indicated that a CPP of 51–60 mmHg correlated with survival, while high age was associated with worse outcome. Conclusion To aim for, or tolerate, lower CPP levels than those recommended in available guidelines did not correlate with unfavorable outcome in adult patients with severe TBI.