Personalized Autoregulation Monitoring Enhances Pediatric TBI Treatment Outcomes

New insights from the STARSHIP study highlight the potential benefits of personalized cerebral perfusion pressure (CPP) management in children with traumatic brain injury (TBI). Traditionally, clinicians have targeted a fixed CPP range of 40-50 mmHg for pediatric patients; however, this approach overlooks individual variations in cerebrovascular autoregulation and age. The recent research evaluated optimal CPP (CPPopt) and the lower limit of autoregulation (LLA) by continuously monitoring pressure reactivity in 135 children across multiple UK intensive care units. The study found that prolonged periods spent below the LLA, particularly when assessed dynamically, were linked to worse clinical outcomes. Notably, children with unfavorable recoveries exhibited an increase in LLA over time, suggesting that adaptive, autoregulation-guided thresholds could enhance treatment personalization. These findings challenge the current fixed CPP targets and propose that dynamic autoregulation monitoring may lead to better prognoses by tailoring therapy to individual patient physiology. While these results are promising, further research through prospective trials is necessary to confirm whether ...