Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: A CENTER-TBI study

Lennart Riemann; Erta Beqiri; Peter Smielewski; Marek Czosnyka; Nino Stocchetti; Oliver Sakowitz; Klaus Zweckberger; Andreas Unterberg; Alexander Younsi; Audny Anke; Ronny Beer; Bo Michael Bellander; Andras Buki; Giorgio Chevallard; Arturo Chieregato; Giuseppe Citerio; Endre Czeiter; Bart Depreitere; George Eapen; Shirin Frisvold; Raimund Helbok; Stefan Jankowski; Daniel Kondziella; Lars Owe Koskinen; Geert Meyfroidt; Kirsten Moeller; David Nelson; Anna Piippo-Karjalainen; Andreea Radoi; Arminas Ragauskas; Rahul Raj; Jonathan Rhodes; Saulius Rocka; Rolf Rossaint; Juan Sahuquillo; Ana Stevanovic; Nina Sundström; Riikka Takala; Tomas Tamosuitis; Olli Tenovuo; Peter Vajkoczy; Alessia Vargiolu; Rimantas Vilcinis; Stefan Wolf

doi:10.1186/s13054-020-02974-8

Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: A CENTER-TBI study

Lennart Riemann, Erta Beqiri, Peter Smielewski, Marek Czosnyka, Nino Stocchetti, Oliver Sakowitz, Klaus Zweckberger, Andreas Unterberg, Alexander Younsi^*, Audny Anke, Ronny Beer, Bo Michael Bellander, Andras Buki, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Endre Czeiter, Bart Depreitere, George Eapen, Shirin FrisvoldRaimund Helbok, Stefan Jankowski, Daniel Kondziella, Lars Owe Koskinen, Geert Meyfroidt, Kirsten Moeller, David Nelson, Anna Piippo-Karjalainen, Andreea Radoi, Arminas Ragauskas, Rahul Raj, Jonathan Rhodes, Saulius Rocka, Rolf Rossaint, Juan Sahuquillo, Ana Stevanovic, Nina Sundström, Riikka Takala, Tomas Tamosuitis, Olli Tenovuo, Peter Vajkoczy, Alessia Vargiolu, Rimantas Vilcinis, Stefan Wolf

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

30 Citationer (Scopus)

35 Downloads (Pure)

Abstract

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.

Originalsprog	Engelsk
Artikelnummer	266
Tidsskrift	Critical Care
Vol/bind	24
Udgave nummer	1
ISSN	1364-8535
DOI	https://doi.org/10.1186/s13054-020-02974-8
Status	Udgivet - 2020

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10.1186/s13054-020-02974-8Licens: CC BY

Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: a CENTER-TBI studyForlagets udgivne version, 960 KBLicens: CC BY

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Riemann, L., Beqiri, E., Smielewski, P., Czosnyka, M., Stocchetti, N., Sakowitz, O., Zweckberger, K., Unterberg, A., Younsi, A., Anke, A., Beer, R., Bellander, B. M., Buki, A., Chevallard, G., Chieregato, A., Citerio, G., Czeiter, E., Depreitere, B., Eapen, G., ... Wolf, S. (2020). Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: A CENTER-TBI study. Critical Care, 24(1), Artikel 266. https://doi.org/10.1186/s13054-020-02974-8

Riemann, L, Beqiri, E, Smielewski, P, Czosnyka, M, Stocchetti, N, Sakowitz, O, Zweckberger, K, Unterberg, A, Younsi, A, Anke, A, Beer, R, Bellander, BM, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, LO, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Stevanovic, A, Sundström, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R & Wolf, S 2020, 'Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: A CENTER-TBI study', Critical Care, bind 24, nr. 1, 266. https://doi.org/10.1186/s13054-020-02974-8

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title = "Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: A CENTER-TBI study",

abstract = "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.",

keywords = "Cerebral autoregulation, Cerebral perfusion pressure, Cerebrovascular reactivity, CPPopt, Traumatic brain injury",

author = "Lennart Riemann and Erta Beqiri and Peter Smielewski and Marek Czosnyka and Nino Stocchetti and Oliver Sakowitz and Klaus Zweckberger and Andreas Unterberg and Alexander Younsi and Audny Anke and Ronny Beer and Bellander, {Bo Michael} and Andras Buki and Giorgio Chevallard and Arturo Chieregato and Giuseppe Citerio and Endre Czeiter and Bart Depreitere and George Eapen and Shirin Frisvold and Raimund Helbok and Stefan Jankowski and Daniel Kondziella and Koskinen, {Lars Owe} and Geert Meyfroidt and Kirsten Moeller and David Nelson and Anna Piippo-Karjalainen and Andreea Radoi and Arminas Ragauskas and Rahul Raj and Jonathan Rhodes and Saulius Rocka and Rolf Rossaint and Juan Sahuquillo and Ana Stevanovic and Nina Sundstr{\"o}m and Riikka Takala and Tomas Tamosuitis and Olli Tenovuo and Peter Vajkoczy and Alessia Vargiolu and Rimantas Vilcinis and Stefan Wolf",

year = "2020",

doi = "10.1186/s13054-020-02974-8",

language = "English",

volume = "24",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd.",

number = "1",

}

TY - JOUR

T1 - Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury

T2 - A CENTER-TBI study

AU - Riemann, Lennart

AU - Beqiri, Erta

AU - Smielewski, Peter

AU - Czosnyka, Marek

AU - Stocchetti, Nino

AU - Sakowitz, Oliver

AU - Zweckberger, Klaus

AU - Unterberg, Andreas

AU - Younsi, Alexander

AU - Anke, Audny

AU - Beer, Ronny

AU - Bellander, Bo Michael

AU - Buki, Andras

AU - Chevallard, Giorgio

AU - Chieregato, Arturo

AU - Citerio, Giuseppe

AU - Czeiter, Endre

AU - Depreitere, Bart

AU - Eapen, George

AU - Frisvold, Shirin

AU - Helbok, Raimund

AU - Jankowski, Stefan

AU - Kondziella, Daniel

AU - Koskinen, Lars Owe

AU - Meyfroidt, Geert

AU - Moeller, Kirsten

AU - Nelson, David

AU - Piippo-Karjalainen, Anna

AU - Radoi, Andreea

AU - Ragauskas, Arminas

AU - Raj, Rahul

AU - Rhodes, Jonathan

AU - Rocka, Saulius

AU - Rossaint, Rolf

AU - Sahuquillo, Juan

AU - Stevanovic, Ana

AU - Sundström, Nina

AU - Takala, Riikka

AU - Tamosuitis, Tomas

AU - Tenovuo, Olli

AU - Vajkoczy, Peter

AU - Vargiolu, Alessia

AU - Vilcinis, Rimantas

AU - Wolf, Stefan

PY - 2020

Y1 - 2020

N2 - 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.

AB - 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.

KW - Cerebral autoregulation

KW - Cerebral perfusion pressure

KW - Cerebrovascular reactivity

KW - CPPopt

KW - Traumatic brain injury

U2 - 10.1186/s13054-020-02974-8

DO - 10.1186/s13054-020-02974-8

M3 - Journal article

C2 - 32456684

AN - SCOPUS:85085423759

SN - 1364-8535

VL - 24

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 266

ER -