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

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. 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. 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. 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.