Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use: A Validation Study
| Autor: | Beqiri, Erta, Ercole, Ari, Aries, Marcel J, Cabeleira, Manuel, Czigler, Andras, Liberti, Annalisa, Tas, Jeanette, Donnelly, Joseph, Liu, Xiuyun, Fedriga, Marta, Chu, Ka Hing, Zeiler, Frederick A, Czosnyka, Marek, Smielewski, Peter, Depreitere, Bart, Meyfroidt, Geert, Güiza, Fabian |
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| Přispěvatelé: | Ercole, Ari [0000-0001-8350-8093], Smielewski, Peter [0000-0001-5096-3938], Apollo - University of Cambridge Repository, Intensive Care, MUMC+: MA Medische Staf IC (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience |
| Rok vydání: | 2021 |
| Předmět: |
Traumatic
Validation study medicine.medical_specialty Intracranial Pressure Traumatic brain injury Autoregulation Neuromonitoring 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Internal medicine Brain Injuries Traumatic Humans Medicine Prospective Studies Cerebral perfusion pressure Traumatic brain injury (TBI) Retrospective Studies Intracranial pressure CPPopt business.industry Precision medicine medicine.disease Pressure reactivity Blood pressure Brain Injuries Cerebrovascular Circulation Cardiology business Perfusion 030217 neurology & neurosurgery |
| Zdroj: | Acta Neurochirurgica Supplement ISBN: 9783030594350 Intracranial Pressure and Neuromonitoring XVII, 131, 181-185 |
| Popis: | BACKGROUND: Pressure reactivity index (PRx)-cerebral perfusion pressure (CPP) relationships over a given time period can be used to detect a value of CPP at which PRx shows the best autoregulation (optimal CPP, or CPPopt). Algorithms for continuous assessment of CPPopt in traumatic brain injury (TBI) patients reached the desired high yield with a multi-window approach (CPPopt_MA). However, the calculations were tested on retrospective manually cleaned datasets. Moreover, CPPopt false-positive values can be generated from non-physiological variations of intracranial pressure (ICP) and arterial blood pressure (ABP). Therefore, the algorithm robustness was improved, making it suitable for prospective bedside application (COGiTATE trial).OBJECTIVE: To validate the CPPopt revised algorithm in a large single-centre retrospective cohort of TBI patients.METHODS: 840 TBI patients were included. CPPopt yield, stability and ability to discriminate outcome groups were compared to CPPopt_MA and the Brain Trauma Foundation (BTF) guideline reference.RESULTS: CPPopt yield was lower than CPPopt_MA yield (85% and 90%, p < 0.001), but, importantly, with increased stability (p < 0.0001). The ∆(CPP-CPPopt) could distinguish the mortality and survival outcome (t = -6.7, p < 0.0001) with a statistical significance higher than the ∆CPP calculated with the guideline reference (CPP-60) (t = -4.5, p < 0.0001).CONCLUSION: This study validates, on a large cohort of patients, the new algorithm proposed for prospective use of CPPopt as a CPP target at bedside. |
| Databáze: | OpenAIRE |
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