Impact of hemodynamic management guided by intracranial compliance on the outcome of critically ill patients – preliminary results and exploratory economic evaluation

BACKGROUND: The optimization of cerebral perfusion through individualized hemodynamic strategies has emerged as a relevant strategy in critical care. The brain4care (B4C) System offers a non-invasive method to monitor intracranial compliance (ICC) via the P2/P1 ratio, a marker of intracranial dynamics. This study evaluated the impact of ICC-guided management on clinical and economic outcomes. METHODS: This retrospective observational study included 102 critically ill patients at the Intensive Care Unit (ICU) of Nove de Julho Hospital, São Paulo, Brazil. Fifty-one patients underwent ICC-guided mean arterial pressure (MAP) management using the B4C System; 51 received standard care. The primary outcome was ICU mortality. Secondary outcomes included 30-day readmission, ICU and total hospital length of stay (LOS), discharge disposition, and Glasgow Coma Scale at discharge. Exploratory outcomes included hospital-perspective cost consequences based on LOS and readmissions. RESULTS: ICC-guided management was associated with lower ICU mortality (5.88% vs. 37.25%, p = 0.0003) and fewer 30-day readmissions (12.50% vs. 38.70%, p = 0.014). ICU and total hospital LOS did not differ significantly between groups. Discharge home was more frequent in the ICC-guided group (58.8% vs. 27.5%). In an exploratory hospital-perspective cost-consequence analysis, readmission-related savings were estimated at USD $3,878 per patient, and LOS-related cost differences were reported as unit-cost impacts and interpreted cautiously given non-significant LOS differences. CONCLUSION: ICC-guided MAP management supported by the B4C System was associated with lower ICU mortality, fewer readmissions, and lower estimated costs. Prospective multicenter studies are needed to confirm these findings.