Association of Outcomes with Model-Based Indices of Cerebral Autoregulation After Pediatric Traumatic Brain Injury

Appavu, Brian; Temkit, Mʼhamed; Foldes, Stephen T.; Burrows, Brian T.; Kuwabara, Michael; Jacobson, Austin; Adelson, P. David

doi:10.1007/s12028-021-01279-0

Cited by 20 publications

(23 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our observation that increased CrCP and reduced DCM are associated with increased ICP is unsurprising, given that ICP characteristics are factored into the calculation of each of these indices of cerebrovascular dynamics. We note that overall Mx values were not associated with functional outcomes, which contrasts findings observed with Mx in adult TBI patients (Czosnyka et al, 1999) as well as other CVPR biomarkers identified in pediatric TBI patients (Brady et al, 2009;Lewis et al, 2015;Appavu et al, 2021). We note that most of the patients within this cohort were also part of a larger cohort in which we previously demonstrated that elevated PRx values were associated with unfavorable outcomes, in addition to other ICP-derived model-based indices of CVPR (Appavu et al, 2021).…”

Section: Association With Lesionscontrasting

confidence: 89%

“…We note that overall Mx values were not associated with functional outcomes, which contrasts findings observed with Mx in adult TBI patients (Czosnyka et al, 1999) as well as other CVPR biomarkers identified in pediatric TBI patients (Brady et al, 2009;Lewis et al, 2015;Appavu et al, 2021). We note that most of the patients within this cohort were also part of a larger cohort in which we previously demonstrated that elevated PRx values were associated with unfavorable outcomes, in addition to other ICP-derived model-based indices of CVPR (Appavu et al, 2021). It remains unclear why we have observed a lack of association to outcome with Mx in opposition to PRx, and we speculate that our sample size may be underpowered to assess such an outcome.…”

Section: Association With Lesionscontrasting

confidence: 89%

“…It is also possible that while PRx and Mx both evaluate CVPR, PRx may offer a better assessment of injury severity whereas Mx may allow for a more precise assessment of regional CVPR. As part of our larger pediatric TBI cohort, we have previously described that we did not identify age or initial GCS as biomarkers predictive of functional outcomes, and we did observe that the dose of intracranial hypertension was associated with unfavorable outcomes (Appavu et al, 2021).…”

Section: Association With Lesionsmentioning

confidence: 77%

See 2 more Smart Citations

Cerebrovascular dynamics after pediatric traumatic brain injury

Hanalioğlu

Burrows²,

Adelson³

et al. 2023

Front. Physiol.

Self Cite

View full text Add to dashboard Cite

Objective: We aimed to investigate model-based indices of cerebrovascular dynamics after pediatric traumatic brain injury (TBI) using transcranial Doppler ultrasound (TCD) integrated into multimodality neurologic monitoring (MMM).Methods: We performed a retrospective analysis of pediatric TBI patients undergoing TCD integrated into MMM. Classic TCD characteristics included pulsatility indices and systolic, diastolic and mean flow velocities of the bilateral middle cerebral arteries. Model-based indices of cerebrovascular dynamics included the mean velocity index (Mx), compliance of the cerebrovascular bed (Ca), compliance of the cerebrospinal space (Ci), arterial time constant (TAU), critical closing pressure (CrCP) and diastolic closing margin (DCM). Classic TCD characteristics and model-based indices of cerebrovascular dynamics were investigated in relation to functional outcomes and intracranial pressure (ICP) using generalized estimating equations with repeated measures. Functional outcomes were assessed using the Glasgow Outcome Scale–Extended Pediatrics score (GOSE-Peds) at 12 months, post-injury.Results: Seventy-two separate TCD studies were performed on twenty-five pediatric TBI patients. We identified that reduced Ci (estimate −5.986, p = 0.0309), increased CrCP (estimate 0.081, p < 0.0001) and reduced DCM (estimate −0.057, p = 0.0179) were associated with higher GOSE-Peds scores, suggestive of unfavorable outcome. We identified that increased CrCP (estimate 0.900, p < 0.001) and reduced DCM (estimate −0.549, p < 0.0001) were associated with increased ICP.Conclusion: In an exploratory analysis of pediatric TBI patients, increased CrCP and reduced DCM and Ci are associated with unfavorable outcomes, and increased CrCP and reduced DCM are associated with increased ICP. Prospective work with larger cohorts is needed to further validate the clinical utility of these features.

show abstract

Section: Association With Lesionscontrasting

confidence: 89%

Section: Association With Lesionscontrasting

confidence: 89%

Section: Association With Lesionsmentioning

confidence: 77%

See 1 more Smart Citation

Cerebrovascular dynamics after pediatric traumatic brain injury

Hanalioğlu

Burrows²,

Adelson³

et al. 2023

Front. Physiol.

Self Cite

View full text Add to dashboard Cite

show abstract

“…One dynamic measurement of cerebrovascular pressure reactivity is PRx, the pressure reactivity index. PRx is arguably the most widely used indication of the status of pressure reactivity in research studies; but there are few studies in children, and the cohort sizes are small, the largest to date consisting of 56 patients (3)(4)(5)(6)(7)(8). It is essential to develop robust pediatric-specific data because children have different physiologic blood pressure ranges across the age continuum, different baseline cerebral blood flow ranges, different cerebrovascular responses to stimuli (9)(10)(11), and different injury patterns.…”

mentioning

confidence: 99%

Cerebrovascular Pressure Reactivity Has a Strong and Independent Association With Outcome in Children With Severe Traumatic Brain Injury*

Smith

Rohlwink

Mauff

et al. 2023

Critical Care Medicine

View full text Add to dashboard Cite

OBJECTIVES: To examine cerebrovascular pressure reactivity index (PRx) in a large cohort of children with severe traumatic brain injury (sTBI) in association with physiologic variables and outcome. DESIGN: Retrospective observational cohort study. SETTING: Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. PATIENTS: Pediatric (≤ 14 yr old) sTBI patients with intracranial pressure (ICP) monitoring (postresuscitation Glasgow Coma Score [Glasgow Coma Scale (GCS)] of ≤ 8). MEASUREMENTS AND MAIN RESULTS: Data were analyzed from ICM+ files sampled at 100Hz. PRx (a mathematical indicator of pressure reactivity) was calculated as a moving correlation coefficient between ICP and mean arterial pressure (MAP) as previously described. Associations between PRx, age, GCS, ICP, MAP, and cerebral perfusion pressure (CPP) were examined with summary measures and correlation analysis using high-frequency data. Associations between PRx and mortality/outcome were examined with multivariable logistic regression analysis and the prognostic ability of PRx with receiver operating characteristic (ROCs) curves. The dataset included over 1.7 million minutes (28,634 hr) of MAP and ICP data in 196 children. The series mortality was 10.7% (21/196), and unfavorable outcome 29.6% (58/196). PRx had a moderate positive correlation with ICP ( r = 0.44; p < 0.001), a moderate negative correlation with CPP ( r = -0.43; p < 0.001), and a weak negative correlation with MAP ( r = –0.21; p = 0.004). PRx was consistently higher in patients with poor outcome and had a strong, independent association with mortality (ROC area under the curve = 0.91). A PRx threshold of 0.25 showed the best predictive ability for mortality. CONCLUSIONS: This is the largest cohort of children with PRx analysis of cerebrovascular reactivity to date. PRx had a strong association with outcome that was independent of ICP, CPP, GCS, and age. The data suggest that impaired autoregulation is an independent factor associated with poor outcome and may be useful in directing clinical care.

show abstract

“…The PRx ranges from -1 to 1, where values above 0 indicate altered or dysfunctional cerebral autoregulation (3). PRx is widely now used in adult clinical studies as a marker of cerebral autoregulation, but only a few small pediatric cohorts are described in the literature (4)(5)(6). With age-dependent differences in blood pressure, cerebral blood flow, and cerebrovascular response, larger pediatric study populations are needed before PRx-based assessments of cerebral autoregulation can be used to guide sTBI management in children.…”

mentioning

confidence: 99%

Pressure Reactivity Index in Children With Severe Traumatic Brain Injury: Are We Getting Closer to Goldilocks Management?*

Friess

2023

Critical Care Medicine

View full text Add to dashboard Cite

Association of Outcomes with Model-Based Indices of Cerebral Autoregulation After Pediatric Traumatic Brain Injury

Cited by 20 publications

References 31 publications

Cerebrovascular dynamics after pediatric traumatic brain injury

Cerebrovascular dynamics after pediatric traumatic brain injury

Cerebrovascular Pressure Reactivity Has a Strong and Independent Association With Outcome in Children With Severe Traumatic Brain Injury*

Pressure Reactivity Index in Children With Severe Traumatic Brain Injury: Are We Getting Closer to Goldilocks Management?*

Contact Info

Product

Resources

About