Critical Care volume 29,
Article number: 420 (2025) Published: 06 October 2025
Abstract
It has been demonstrated that patient-specific intracranial
pressure (ICP) thresholds are possible to derive using the function
intersectionality between ICP and cerebrovascular reactivity (CVR). Such
individualized ICP (iICP) thresholds represent a potential personalized
medicine approach to neurocritical care management. However, it is currently
unknown how various CVR thresholds compare in regard to deriving iICP. Here we
attempt to identify the CVR thresholds that are best suited for iICP derivation.
Leveraging 365 patient data sets from the CAnadian High-Resolution TBI
(CAHR-TBI) Research Collaborative, iICP was derived using three ICP-based CVR
indices: the pressure reactivity index (PRx); the pulse amplitude index (PAx);
and the RAC index, and thresholds ranging from − 1
to + 1, in 0.05 increments.
Patients were dichotomized based on 6-month outcome scores into Alive vs. Dead
and Favorable vs. Unfavorable outcome. 2 × 2 tables
were created for each threshold, grouping patients by outcome and whether their
mean ICP was greater or less than their calculated iICP. Chi-squares were
calculated for each table and subsequently plotted. The thresholds that
produced the largest Chi-square values were identified as those able to derive
the iICP with the greatest ability to predict outcomes. Next, Spearman rank
correlation testing was used to evaluate associations between iICP, for each
threshold, and measures of cerebral physiologic insult burden. With
consideration of yield data, ability to predict outcome, and association with
cerebral physiologic insult burden, a threshold of + 0.05 was identified for PRx. No optimal threshold
could be identified for PAx or RAC.
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