Abstract
Purpose: CPPopt denotes a Cerebral Perfusion Pressure (CPP) value at which the Pressure-Reactivity index, reflecting the global state of Cerebral Autoregulation, is best preserved. CPPopt has been investigated as a potential dynamically individualised CPP target in traumatic brain injury patients admitted in intensive care unit. The prospective bedside use of the concept requires ensured safety and reliability of the CPP recommended targets based on the automatically-generated CPPopt. We aimed to: Increase stability and reliability of the CPPopt automated algorithm by fine-tuning; perform outcome validation of the adjusted algorithm in a multi-centre TBI cohort. Methods: ICM + software was used to derive CPPopt and fine-tune the algorithm. Parameters for improvement of the algorithm were selected based on qualitative and quantitative assessment of stability and reliability metrics. Patients enrolled in the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution cohort were included for retrospective validation. Yield and stability of the new algorithm were compared to the previous algorithm using Mann–U test. Area under the curves for mortality prediction at 6 months were compared with the DeLong Test. Results: CPPopt showed higher stability (p < 0.0001), but lower yield compared to the previous algorithm [80.5% (70—87.5) vs 85% (75.7—91.2), p < 0.001]. Deviation of CPPopt could predict mortality with an AUC of [AUC = 0.69 (95% CI 0.59–0.78), p < 0.001] and was comparable with the previous algorithm. Conclusion: The CPPopt calculation algorithm was fine-tuned and adapted for prospective use with acceptable lower yield, improved stability and maintained prognostic power.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Journal of Clinical Monitoring and Computing |
| Vol/bind | 37 |
| Udgave nummer | 4 |
| Sider (fra-til) | 963-976 |
| Antal sider | 14 |
| ISSN | 1387-1307 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:The authors would like to thank Abhishek Dixit for his contribution to the core CENTER-TBI database using Opal software and his guidance for data retrieval and interpretation. The authors would like to thank Shubhayu Bhattacharyay for their help with data retrieval from the core CENTER-TBI database. Here below we list the investigators of the collaborative group listed as author. CENTER-TBI High Resolution (HR ICU) Sub-Study Participants and Investigators: Audny Anke 1, Ronny Beer 2, Bo-Michael Bellander3, Erta Beqiri4, Andras Buki5, Manuel Cabeleira6, Marco Carbonara7, Arturo Chieregato4, Giuseppe Citerio8, 9, Hans Clusmann10, Endre Czeiter11, Marek Czosnyka6, Bart Depreitere12, Ari Ercole13, Shirin Frisvold14, Raimund Helbok2, Stefan Jankowski15, Daniel Kondziella16, Lars-Owe Koskinen17, Ana Kowark18, David K. Menon13, Geert Meyfroidt19, Kirsten Moeller20, David Nelson3, Anna Piippo-Karjalainen21, Andreea Radoi22, Arminas Ragauskas23, Rahul Raj21, Jonathan Rhodes24, Saulius Rocka23, Rolf Rossaint18, Juan Sahuquillo22, Oliver Sakowitz25, 26, Peter Smielewski6, Nino Stocchetti27, Nina Sundström28, Riikka Takala29, Tomas Tamosuitis30, Olli Tenovuo31, Andreas Unterberg26, Peter Vajkoczy32, Alessia Vargiolu8, Rimantas Vilcinis33, Stefan Wolf34, Alexander Younsi26, Frederick A. Zeiler13,35.1 Department of Physical Medicine and Rehabilitation, University hospital Northern Norway,2 Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria,3 Department of Neurosurgery & Anesthesia & intensive care medicine, Karolinska University Hospital, Stockholm, Sweden,4 NeuroIntensive Care, Niguarda Hospital, Milan, Italy,5 Department of Neurosurgery, Medical School, University of Pécs, Hungary and Neurotrauma Research Group, János Szentágothai Research Centre, University of Pécs, Hungary,6Brain Physics Lab, Division of Neurosurgery, Dept of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK,7Neuro ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy,8NeuroIntensive Care Unit, Department of Anesthesia & Intensive Care, ASST di Monza, Monza, Italy,9School of Medicine and Surgery, Università Milano Bicocca, Milano, Italy,10Department of Neurosurgery, Medical Faculty RWTH Aachen University, Aachen, Germany,11Department of Neurosurgery, University of Pecs and MTA-PTE Clinical Neuroscience MR Research Group and Janos Szentagothai Research Centre, University of Pecs, Hungarian Brain Research Program (Grant No. KTIA 13 NAP-A-II/8), Pecs, Hungary,12Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium,13Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK,14Department of Anesthesiology and Intensive care, University Hospital Northern Norway, Tromso, Norway,15Neurointensive Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK,16 Departments of Neurology, Clinical Neurophysiology and Neuroanesthesiology, Region Hovedstaden Rigshospitalet, Copenhagen, Denmark,17Department of Clinical Neuroscience, Neurosurgery, Umeå University, Umeå, Sweden,18Department of Anaesthesiology, University Hospital of Aachen, Aachen, Germany,19Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium,20Department Neuroanesthesiology, Region Hovedstaden Rigshospitalet, Copenhagen, Denmark,21Helsinki University Central Hospital, Helsinki, Finland,22Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain,23Department of Neurosurgery, Kaunas University of technology and Vilnius University, Vilnius, Lithuania,24Department of Anaesthesia, Critical Care & Pain Medicine NHS Lothian & University of Edinburg, Edinburgh, UK,25Klinik für Neurochirurgie, Klinikum Ludwigsburg, Ludwigsburg, Germany,26Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany,27Department of Pathophysiology and Transplantation, Milan University, and Neuroscience ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy,28Department of Radiation Sciences, Biomedical Engineering, Umea University, Umea, Sweden,29Perioperative Services, Intensive Care Medicine, and Pain Management , Turku University Central Hospital and University of Turku, Turku, Finland,30Neuro-intensive Care Unit, Kaunas University of Health Sciences, Kaunas, Lithuania,31Rehabilitation and Brain Trauma, Turku University Central Hospital and University of Turku, Turku, Finland,32Neurologie, Neurochirurgie und Psychiatrie, Charité – Universitätsmedizin Berlin, Berlin, Germany,33Department of Neurosurgery, Kaunas University of Health Sciences, Kaunas, Lithuania,34Department of Neurosurgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,35Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Funding Information:
CENTER-TBI was supported by the Framework 7 program of the European Union (602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), from Integra LifeSciences Corporation (USA), and from NeuroTrauma Sciences (USA). For the writing of this manuscript Erta Beqiri was supported by CTBI scholarship (EC grant n°:602150) and is currently supported by the Medical Research Council (grant no.: MR N013433-1) and by the Gates Cambridge Scholarship. Michał M. Placek was supported by the European Union seventh Framework Program (grant 602150) for Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) until March 2021 and by Action Medical Research (grant GN2609) for Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics (STARSHIP). Marcel J. Aries and Jeanette Tas are supported by ‘‘HersenStrijd fonds’’ (translated as ‘‘Brain Battle foundation’’), a non-profit foundation of the University Maastricht, Maastricht, The Netherlands.
Publisher Copyright:
© 2023, The Author(s).