Abstract TMP85: Optimizing Mean Arterial Pressure in Acutely Comatose Patients Using Cerebral Autoregulation Multimodal Monitoring With Near-Infrared Spectroscopy

Introduction: The cerebral oximetry index (COx) is a validated marker of cerebral autoregulation derived from near-infrared spectroscopy (NIRS) in comatose patients with acute neurological injury. The utility of this non-invasive technique to determine the optimal arterial blood pressure (MAP OPT ) at the bedside in this population is not known. This study investigated whether comatose patients with greater duration and magnitude of clinically observed MAP outside MAP OPT have worse functional outcomes and increase mortality than those with MAP closer to MAP OPT calculated by bedside multimodal monitoring using NIRS. Methods: In this prospective observational study COx was continuously monitored with NIRS for up to three days in acutely comatose patients secondary to brain injury admitted to a neurocritical care unit. MAP OPT was defined as that MAP at the lowest COx (nadir index) for each 24 hour period of monitoring. Kaplan-Meier analysis and proportional hazard regression models were used to determine if survival at 3 months was associated with a shorter duration of MAP outside MAP OPT and the absolute difference between clinically observed MAP and MAP OPT (