Reliability and variability of pressure reactivity index (prx) during oscillatory pattern in arterial blood pressure and intracranial pressure in traumatic brain injured patients.

Autor:	Motroni V; Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK.; Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Italy., Cucciolini G; Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK.; Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Italy., Beqiri E; Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK., Smith CA; Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK., Placek M; Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK., Chu KH; Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK., Czosnyka M; Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK., Smielewski P; Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK.
Jazyk:	angličtina
Zdroj:	Brain & spine [Brain Spine] 2024 Jun 10; Vol. 4, pp. 102850. Date of Electronic Publication: 2024 Jun 10 (Print Publication: 2024).
DOI:	10.1016/j.bas.2024.102850
Abstrakt:	Introduction: Pressure reactivity index (PRx) is used for continuous monitoring of cerebrovascular reactivity in traumatic brain injury (TBI). However, PRx has a noisy character. Oscillations in arterial blood pressure (ABP) introduced by cyclic positive end-expiratory pressure adjustment, can make PRx more reliable. However, if oscillations are introduced by the cycling process of an anti-decubitus-mattress the effect on PRx is confounding, as they affect directly also intracranial pressure (ICP). In our routine monitoring in TBI patients we noticed periods of highly regular, slow, spontaneous oscillations in ABP and ICP signals. Research Question: We set out to explore the nature of these oscillations and establish if PRx remains reliable during the oscillations. Materials and Methods: 10 TBI patients' recordings with oscillations in ICP and ABP were analysed. We computed PRx, PRx variability (hourly-average of standard-deviation, SD), phase-shift and coherence between ABP and ICP in the slow frequency range. Metrics were compared between oscillation and peri-oscillation periods. Results: During oscillations (frequency 0.006 ± 0.002Hz), a significantly lower variability of PRx (SD 0.185vs0.242) and higher coherence ABP-ICP (0.618 ± 0.09 vs 0.534 ± 0.09) were observed. No external oscillations sources could be identified. 34 out of 48 events showed signs of 'active' transmission associated with negative PRx, indicating a potential positive impact on PRx reliability. Discussion and Conclusions: Spontaneous oscillations observed in ABP and ICP signals were found to enhance rather than confound PRx reliability. Further research is warranted to elucidate the nature of these oscillations and develop strategies to leverage them for enhancing PRx reliability in TBI monitoring. Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Peter Smielewski, Marek Czosnyka has patent with royalties paid to Cambridge enterprise ltd, University of Cambridge, Cambridge. (© 2024 The Authors.)
Databáze:	MEDLINE
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