Index of Pressure Reactivity and Optimal CPP

Impaired vascular reactivity and loss of intracranial compliance will result in ICP changes driven by MAP fluctuations, a concept reflected in the index of pressure reactivity (PRx).

positive PRx 

  • positive linear correlation between changes in MAP
  • reveals an impaired autoregulatory state
  • associated with poor outcome following TBI within first 48 h


optimal CPP (CPPopt)

  • can be defined using the PRx
  • concept:  identify a narrow range of CPPs within a patient’s recent real-time data that reflects the state in which there was optimal cerebral vasoreactivity (lowest PRx)
  • can be used to spare patients from detriments of passive pressure changes in the autoregulation-impaired brain
  • retropective studies showed
    • improved outcomes when CPP approximated CPPopt
    • higher motality when CPP below CPPopt
    • increased survival but worse outcome when CPP elevated above CPPopt



Roh, David and Soojin Park. “Brain Multimodality Monitoring: Updated Perspectives”. Current Neurology and Neuroscience Reports 16.6 (2016): n. pag. Web.


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