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The first 10\u00a0days were divided into early (day 1\u20133), early vasospasm (day 4\u20136.5), and late vasospasm phase (day 6.5\u201310). The monitoring time (%) of ICP insults (&gt;\u200920\u00a0mmHg and\u2009&gt;\u200925\u00a0mmHg), CPP insults (&lt;\u200960\u00a0mmHg,\u2009&lt;\u200970\u00a0mmHg,\u2009&lt;\u200980\u00a0mmHg, and\u2009&lt;\u200990\u00a0mmHg), and autoregulatory CPP optimum (CPPopt) insults (\u2206CPPopt\u2009=\u2009CPP-CPPopt\u2009&lt;\u2009\u2009\u2212\u200910\u00a0mmHg, \u2206CPPopt\u2009&gt;\u200910\u00a0mmHg, and within the optimal interval \u2206CPPopt\u2009\u00b1\u200910\u00a0mmHg) were calculated in each phase.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Higher percent of ICP above the 20\u00a0mmHg and 25\u00a0mmHg thresholds correlated with lower MD-glucose and increased MD-lactate-pyruvate ratio (LPR), particularly in the vasospasm phases. Higher percentage of CPP below all four thresholds (60\/70\/80\/\/90\u00a0mmHg) also correlated with a MD pattern of poor cerebral substrate supply (MD-LPR\u2009&gt;\u200940 and MD-pyruvate\u2009&lt;\u2009120\u00a0\u00b5M) in the vasospasm phase and higher burden of CPP below 60\u00a0mmHg was independently associated with higher MD-LPR in the late vasospasm phase. Higher percentage of CPP deviation from CPPopt did not correlate with worse cerebral energy metabolism. Higher burden of CPP-insults below all fixed thresholds in both vasospasm phases were associated with worse clinical outcome. The percentage of ICP-insults and CPP close to CPPopt were not associated with clinical outcome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Keeping ICP below 20\u00a0mmHg and CPP at least above 60\u00a0mmHg may improve cerebral energy metabolism and clinical outcome.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00701-022-05169-y","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T17:03:13Z","timestamp":1646154193000},"page":"1001-1014","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Intracranial pressure- and cerebral perfusion pressure threshold-insults in relation to cerebral energy metabolism in aneurysmal subarachnoid hemorrhage"],"prefix":"10.1007","volume":"164","author":[{"given":"Teodor","family":"Svedung Wettervik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"H\u00e5nell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Howells","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Ronne-Engstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Lew\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Enblad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,1]]},"reference":[{"key":"5169_CR1","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1097\/CCM.0b013e3182514eb6","volume":"40","author":"MJ Aries","year":"2012","unstructured":"Aries MJ, Czosnyka M, Budohoski KP, Steiner LA, Lavinio A, Kolias AG, Hutchinson PJ, Brady KM, Menon DK, Pickard JD, Smielewski P (2012) Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. 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