Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: a CENTER-TBI study.
CPPopt
Cerebral autoregulation
Cerebral perfusion pressure
Cerebrovascular reactivity
Traumatic brain injury
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
26 05 2020
26 05 2020
Historique:
received:
17
12
2019
accepted:
12
05
2020
entrez:
28
5
2020
pubmed:
28
5
2020
medline:
14
1
2021
Statut:
epublish
Résumé
After traumatic brain injury (TBI), brain tissue can be further damaged when cerebral autoregulation is impaired. Managing cerebral perfusion pressure (CPP) according to computed "optimal CPP" values based on cerebrovascular reactivity indices might contribute to preventing such secondary injuries. In this study, we examined the discriminative value of a low-resolution long pressure reactivity index (LPRx) and its derived "optimal CPP" in comparison to the well-established high-resolution pressure reactivity index (PRx). Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study dataset, the association of LPRx (correlation between 1-min averages of intracranial pressure and arterial blood pressure over a moving time frame of 20 min) and PRx (correlation between 10-s averages of intracranial pressure and arterial blood pressure over a moving time frame of 5 min) to outcome was assessed and compared using univariate and multivariate regression analysis. "Optimal CPP" values were calculated using a multi-window algorithm that was based on either LPRx or PRx, and their discriminative ability was compared. LPRx and PRx were both significant predictors of mortality in univariate and multivariate regression analysis, but PRx displayed a higher discriminative ability. Similarly, deviations of actual CPP from "optimal CPP" values calculated from each index were significantly associated with outcome in univariate and multivariate analysis. "Optimal CPP" based on PRx, however, trended towards more precise predictions. LPRx and its derived "optimal CPP" which are based on low-resolution data were significantly associated with outcome after TBI. However, they did not reach the discriminative ability of the high-resolution PRx and its derived "optimal CPP." Nevertheless, LPRx might still be an interesting tool to assess cerebrovascular reactivity in centers without high-resolution signal monitoring. ClinicalTrials.gov Identifier: NCT02210221. First submitted July 29, 2014. First posted August 6, 2014.
Sections du résumé
BACKGROUND
After traumatic brain injury (TBI), brain tissue can be further damaged when cerebral autoregulation is impaired. Managing cerebral perfusion pressure (CPP) according to computed "optimal CPP" values based on cerebrovascular reactivity indices might contribute to preventing such secondary injuries. In this study, we examined the discriminative value of a low-resolution long pressure reactivity index (LPRx) and its derived "optimal CPP" in comparison to the well-established high-resolution pressure reactivity index (PRx).
METHODS
Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study dataset, the association of LPRx (correlation between 1-min averages of intracranial pressure and arterial blood pressure over a moving time frame of 20 min) and PRx (correlation between 10-s averages of intracranial pressure and arterial blood pressure over a moving time frame of 5 min) to outcome was assessed and compared using univariate and multivariate regression analysis. "Optimal CPP" values were calculated using a multi-window algorithm that was based on either LPRx or PRx, and their discriminative ability was compared.
RESULTS
LPRx and PRx were both significant predictors of mortality in univariate and multivariate regression analysis, but PRx displayed a higher discriminative ability. Similarly, deviations of actual CPP from "optimal CPP" values calculated from each index were significantly associated with outcome in univariate and multivariate analysis. "Optimal CPP" based on PRx, however, trended towards more precise predictions.
CONCLUSIONS
LPRx and its derived "optimal CPP" which are based on low-resolution data were significantly associated with outcome after TBI. However, they did not reach the discriminative ability of the high-resolution PRx and its derived "optimal CPP." Nevertheless, LPRx might still be an interesting tool to assess cerebrovascular reactivity in centers without high-resolution signal monitoring.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02210221. First submitted July 29, 2014. First posted August 6, 2014.
Identifiants
pubmed: 32456684
doi: 10.1186/s13054-020-02974-8
pii: 10.1186/s13054-020-02974-8
pmc: PMC7251676
doi:
Banques de données
ClinicalTrials.gov
['NCT02210221']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
266Subventions
Organisme : FP7 Health
ID : EC grant 602150
Pays : International
Organisme : ZNS - Hannelore Kohl Stiftung
ID : -
Pays : International
Organisme : OneMind (US)
ID : -
Pays : International
Organisme : Integra LifeSciences
ID : -
Pays : International
Investigateurs
Audny Anke
(A)
Ronny Beer
(R)
Bo-Michael Bellander
(BM)
Andras Buki
(A)
Giorgio Chevallard
(G)
Arturo Chieregato
(A)
Giuseppe Citerio
(G)
Endre Czeiter
(E)
Bart Depreitere
(B)
George Eapen
(G)
Shirin Frisvold
(S)
Raimund Helbok
(R)
Stefan Jankowski
(S)
Daniel Kondziella
(D)
Lars-Owe Koskinen
(LO)
Geert Meyfroidt
(G)
Kirsten Moeller
(K)
David Nelson
(D)
Anna Piippo-Karjalainen
(A)
Andreea Radoi
(A)
Arminas Ragauskas
(A)
Rahul Raj
(R)
Jonathan Rhodes
(J)
Saulius Rocka
(S)
Rolf Rossaint
(R)
Juan Sahuquillo
(J)
Ana Stevanovic
(A)
Nina Sundström
(N)
Riikka Takala
(R)
Tomas Tamosuitis
(T)
Olli Tenovuo
(O)
Peter Vajkoczy
(P)
Alessia Vargiolu
(A)
Rimantas Vilcinis
(R)
Stefan Wolf
(S)
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