Pressure Autoregulation Measurement Techniques in Adult Traumatic Brain Injury, Part I: A Scoping Review of Intermittent/Semi-Intermittent Methods

Zeiler, Frederick A.; Donnelly, Joseph E.; Calviello, Leanne; Menon, David; Smielewski, Peter; Czosnyka, Marek

doi:10.1089/neu.2017.5085

Cited by 40 publications

(50 citation statements)

References 64 publications

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“…All patients were managed in accordance with an ICP/CPP-oriented protocol designed to maintain ICP below 20 mm Hg. The exact protocol changed several times over the monitoring period, but its essential components were stable [10].…”

Section: Patientsmentioning

confidence: 99%

Validation of non-invasive cerebrovascular pressure reactivity and pulse amplitude reactivity indices in traumatic brain injury

et al. 2019

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Background Two transcranial Doppler (TCD) estimators of cerebral arterial blood volume (CaBV) coexist: continuous outflow of arterial blood outside the cranium through a low-pulsatile venous system (continuous flow forward, CFF) and pulsatile outflow through regulating arterioles (pulsatile flow forward, PFF). We calculated non-invasive equivalents of the pressure reactivity index (PRx) and the pulse amplitude index PAx with slow waves of mean CaBV and its pulse amplitude. Methods About 273 individual TBI patients were retrospectively reviewed. PRx is the correlation coefficient between 30 samples of 10-second averages of ICP and mean ABP. PAx is the correlation coefficient between 30 samples of 10-second averages of the amplitude of ICP (AMP, derived from Fourier analysis of the raw full waveform ICP tracing) and mean ABP. nPRx is calculated with CaBV instead of ICP and nPAx with the pulse amplitude of CaBV instead of AMP (calculated using both the CFF and PFF models). All reactivity indices were additionally compared with Glasgow Outcome Score (GOS) to verify potential outcome-predictive strength. Results When correlated, slow waves of ICP demonstrated good coherence between slow waves in CaBV (>0.75); slow waves of AMP showed good coherence with slow waves of the pulse amplitude of CaBV (>0.67) in both the CFF and PFF models. nPRx was moderately correlated with PRx (R = 0.42 for CFF and R = 0.38 for PFF; p < 0.0001). nPAx correlated with PAx with slightly better strength (R = 0.56 for CFF and R = 0.41 for PFF; p < 0.0001). nPAx_CFF showed the strongest association with outcomes. Conclusions Non-invasive estimators (nPRx and nPAx) are associated with their invasive counterparts and can provide meaningful associations with outcome after TBI. The CFF model is slightly superior to the PFF model.

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Section: Patientsmentioning

confidence: 99%

Validation of non-invasive cerebrovascular pressure reactivity and pulse amplitude reactivity indices in traumatic brain injury

et al. 2019

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“…Correlations are calculated during 300 seconds in the supine position (rest) and 300 seconds during head up tilt with 70 degrees head elevation. The Mxa will then principally be considered dichotomously in order to reflect intact cerebral autoregulation of blood flow, with a correlation equal to or below 0.3 or impaired if it is above 0.3 [15]. Data at four weeks will be compared between groups.…”

Section: Exploratory Physiological Outcomesmentioning

confidence: 99%

Statistical analysis plan for early mobilisation by head-up tilt with stepping versus standard care after severe traumatic brain injury – a randomised clinical feasibility trial

Riberholt

Gluud

Jakobsen

et al. 2019

Preprint

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Background: Early mobilisation on a tilt table with stepping versus standard care may be beneficial for patients with severe brain injury, but data from randomised clinical trials are lacking. Methods: This statistical analysis plan describes the analyses of the data collected in the randomised clinical feasibility trial for early mobilisation by head-up tilt with stepping versus standard care after severe traumatic brain injury. The primary feasibility outcomes are the proportion of included participants who were randomised compared with all screened patients; the proportion of participants allocated to the experimental intervention who received at least 60% of the planned exercise sessions; and safety outcomes such as severe adverse events and reactions and adverse events and reactions. Exploratory clinical outcomes are suspected unexpected severe adverse reactions, the coma recovery scale – revised, the early functional ability scale, and the functional independence measure. Explorative physiological outcomes are electrocardiography, mean arterial pressure, middle cerebral artery blood flow velocity all obtained during the head-up tilt test. From the first head-up tilt test and five days onwards, a continuous electrocardiographic heart rate was measured. The detailed description includes the statistical analysis including use of multiple imputation and Trial Sequential Analysis. Conclusions: The present statistical analysis plan serves to minimise potential trial reporting bias and selective P hacking and to improve transparency. This feasibility trial will be used for deciding to launch and designing a larger multicentre randomised clinical trial. Trial registration: ClinicalTrials.gov identifier: NCT02924649. Registered on 3 October 2016.

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“…Numerous other continuous indices of cerebrovascular reactivity exist in the TBI literature [ 31 , 32 ], derived from other invasive and non-invasive monitoring devices, including transcranial Doppler (TCD)-based measures. Indices based on TCD mean flow velocity (FVm) and systolic flow velocity (FVs) have been linked to global outcome in adult TBI [ 6 , 22 ] and are known to be reasonably strongly associated with ICP-derived indices, such as PRx [ 30 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Optimal cerebral perfusion pressure via transcranial Doppler in TBI: application of robotic technology

2018

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Individualized cerebral perfusion pressure (CPP) targets may be derived via assessing the minimum of the parabolic relationship between an index of cerebrovascular reactivity and CPP. This minimum is termed the optimal CPP (CPPopt), and literature suggests that the further away CPP is from CPPopt, the worse is clinical outcome in adult traumatic brain injury (TBI). Typically, CPPopt estimation is based on intracranial pressure (ICP)-derived cerebrovascular reactivity indices, given ICP is commonly measured and provides continuous long duration data streams. The goal of this study is to describe for the first time the application of robotic transcranial Doppler (TCD) and the feasibility of determining CPPopt based on TCD autoregulation indices.Electronic supplementary materialThe online version of this article (10.1007/s00701-018-3687-5) contains supplementary material, which is available to authorized users.

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Pressure Autoregulation Measurement Techniques in Adult Traumatic Brain Injury, Part I: A Scoping Review of Intermittent/Semi-Intermittent Methods

Cited by 40 publications

References 64 publications

Validation of non-invasive cerebrovascular pressure reactivity and pulse amplitude reactivity indices in traumatic brain injury

Validation of non-invasive cerebrovascular pressure reactivity and pulse amplitude reactivity indices in traumatic brain injury

Statistical analysis plan for early mobilisation by head-up tilt with stepping versus standard care after severe traumatic brain injury – a randomised clinical feasibility trial

Optimal cerebral perfusion pressure via transcranial Doppler in TBI: application of robotic technology

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