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Outcome in adult patients with severe TBI, using a management protocol allowing a cerebral perfusion pressure ≤ 60 mmHg – a retrospective study over 10 years

Réen, Linus LU ; Radman, Anna ; Visse, Edward LU ; Cederberg, David LU ; Marklund, Niklas LU orcid and Siesjö, Peter LU orcid (2025) In Acta Neurochirurgica 167(1).
Abstract

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 treatment algorithm employs metoprolol and clonidine to limit CPP, accepting levels below 60 mmHg, with the aim of reducing cerebral edema. Previous reports on this algorithm have shown promising outcome in severe TBI cohorts when compared with many contemporary practices; however, no population-based studies have been conducted to validate these findings. Research Question: What is the outcome in adult severe TBI using the Lund Concept algorithm in a population-based cohort and how are... (More)

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 treatment algorithm employs metoprolol and clonidine to limit CPP, accepting levels below 60 mmHg, with the aim of reducing cerebral edema. Previous reports on this algorithm have shown promising outcome in severe TBI cohorts when compared with many contemporary practices; however, no population-based studies have been conducted to validate these findings. Research Question: What is the outcome in adult severe TBI using the Lund Concept algorithm in a population-based cohort and how are CPP levels lower than 60 mmHg tolerated? Methods: The study included 135 evaluable adult patients out of 171 admitted with severe 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. A favorable outcome (GOSE 5–8) was achieved in 48% of patients. Only increasing age was associated with inferior outcomes. Conclusion: The use of a management protocol accepting lower CPP levels than those recommended in existing guidelines was generally well tolerated with outcome in line with comparable reports.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cerebral perfusion pressure, Glasgow Outcome Scale – extended (GOS-E), Intracranial pressure, Lund Concept, Neurointensive care, Traumatic brain injury
in
Acta Neurochirurgica
volume
167
issue
1
article number
278
publisher
Springer
external identifiers
  • scopus:105019528683
  • pmid:41128918
ISSN
0001-6268
DOI
10.1007/s00701-025-06701-6
language
English
LU publication?
yes
id
d1c9dae3-e951-4cca-80a7-35a493b7f30c
date added to LUP
2025-12-10 13:54:49
date last changed
2025-12-11 03:00:08
@article{d1c9dae3-e951-4cca-80a7-35a493b7f30c,
  abstract     = {{<p>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 treatment algorithm employs metoprolol and clonidine to limit CPP, accepting levels below 60 mmHg, with the aim of reducing cerebral edema. Previous reports on this algorithm have shown promising outcome in severe TBI cohorts when compared with many contemporary practices; however, no population-based studies have been conducted to validate these findings. Research Question: What is the outcome in adult severe TBI using the Lund Concept algorithm in a population-based cohort and how are CPP levels lower than 60 mmHg tolerated? Methods: The study included 135 evaluable adult patients out of 171 admitted with severe 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. A favorable outcome (GOSE 5–8) was achieved in 48% of patients. Only increasing age was associated with inferior outcomes. Conclusion: The use of a management protocol accepting lower CPP levels than those recommended in existing guidelines was generally well tolerated with outcome in line with comparable reports.</p>}},
  author       = {{Réen, Linus and Radman, Anna and Visse, Edward and Cederberg, David and Marklund, Niklas and Siesjö, Peter}},
  issn         = {{0001-6268}},
  keywords     = {{Cerebral perfusion pressure; Glasgow Outcome Scale – extended (GOS-E); Intracranial pressure; Lund Concept; Neurointensive care; Traumatic brain injury}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Springer}},
  series       = {{Acta Neurochirurgica}},
  title        = {{Outcome in adult patients with severe TBI, using a management protocol allowing a cerebral perfusion pressure ≤ 60 mmHg – a retrospective study over 10 years}},
  url          = {{http://dx.doi.org/10.1007/s00701-025-06701-6}},
  doi          = {{10.1007/s00701-025-06701-6}},
  volume       = {{167}},
  year         = {{2025}},
}