A Harmonised Protocol for the Use of PRx in Adult and Paediatric TBI Patients with ICP Monitoring: CLINICCA Workgroup Output
Year: 2026
Type: article
Abstract: INTRODUCTION: A survey of 44 worldwide clinical experts in continuous monitoring of cerebral autoregulation (CCA) revealed that while half used a CCA index in clinical decision making, only 39% were using it as part of a local clinical protocol (CLINICCA survey, 2023). We aimed to distil common elements from existing protocols, focusing on the intracranial pressure (ICP) derived pressure reactivity index (PRx) in traumatic brain injury (TBI). METHODOLOGY: A template for a protocol followed the structure of the original CLINICCA survey which included five components: (1) PRx value triggering further clinical review, (2) PRx value informing approach to intracranial hypertension management, (3) derived CPP targets used to 'optimise' brain physiology, (4) derived CPP targets used to decrease the burden of therapy and (5) use of PRx and derived CPP targets in a stepwise approach within a multimodality protocol. Each component included four contingencies: 'what', 'when', 'advantages' and 'reservations'. Respondents using PRx and/or derived CPP targets in adult or paediatric TBI were invited to edit the template, submit local protocols, and provide clinical practice examples. Feedback was harmonised into a final protocol. RESULTS: Contributors from nine centres edited the template, and two centres submitted written protocols. Most centres expanded components related to PRx status prompting clinical review and informing intracranial hypertension management. Variability existed in the use of derived CPP targets and neuromonitoring modalities incorporated into implementation of multimodality monitoring based practice. A supplement for technical advice regarding PRx use was created. CONCLUSIONS: Creating a harmonised protocol on the basis of common themes amongst currently used clinical protocols and approaches might facilitate broader implementation of CCA-guided therapy and inform future clinical trial design. Sharing protocols and identifying variability may promote discussion regarding advantages and limitations of PRx use in TBI.
Source: Neurocritical Care
Authors: Erta Beqiri, Andrea Lavinio, Celeste Dias, Cornelia Hoedemaekers, Bart Depreitere, Raimund Helbok, Miriam Weiss, Gerrit Schubert, Matthew Kirschen, Brian Appavu, Shirin Frisvold, Soojin Park, Peter Smielewski, Marcel Aries, Francisco Abecasis, Shruti Agrawal, Brian Appavu, Ramani Balu, Ken Brady, Celina Brunsch, Karol Budohoski, András Czigler, Bart Depreitere, Celeste Dias, Per Enblad, Ari Ercole, Anthony Figaji, Brandon Foreman, Shirin K. Frisvold, Clare Gallagher, Donald Griesdale, Raimund Helbok, Adel Helmy, Cornelia Hoedemaekers, Matthew Kirschen, Elisabeth Kooi, Andreas Kramer, Andrea Lavinio, Jennifer K. Lee, Victoria McCredie, David K. Menon, Geert Meyfroidt, David Nelson, Nils Petersen, Nicolas de Riva, Lucia Rivera-Lara, Chiara Robba, Gerrit Schubert, Martin U. Schuhmann, Mypinder S. Sekhon, Josef Skola, Luzius A. Steiner, Teodor Svedung Wettervik, Fabio S. Taccone, Peter J. Toth, Miriam Weiss, Stefan Wolf, Frederick Zeiler, Wendy Ziai
Institutions: University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Hospital de São João, Radboud University Medical Center, Universitair Ziekenhuis Leuven, Johannes Kepler University of Linz, Kepler Universitätsklinikum, University of Bern, Kantonsspital Aarau, Universitätsklinikum Aachen, RWTH Aachen University, Children's Hospital of Philadelphia, University of Pennsylvania, University of Arizona College of Medicine- Phoenix, University Hospital of North Norway, UiT The Arctic University of Norway, NewYork–Presbyterian Hospital, Columbia University, Maastricht University, Hospital de Santa Maria, Addenbrooke's Hospital, Northwestern University, University Medical Center Groningen, University of Groningen, Beatrix Kinderziekenhuis, University of Utah, University of Pecs, University of Cape Town, Groote Schuur Hospital, University of Cincinnati, University of Calgary, Johns Hopkins University, Johns Hopkins Medicine, Johns Hopkins Hospital, University of Toronto, Karolinska University Hospital, Yale University, Hospital Clínic de Barcelona, Universitat de Barcelona, Stanford Medicine, Stanford University, Ospedale Policlinico San Martino, University of Genoa, University Children's Hospital Tübingen, University of Tübingen, Czech Technical University in Prague, University Hospital of Basel, Uppsala University, University of Manitoba
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,690
OpenAlex ID: W7203822254