Autoregulatory model comparison and optimisation methodology

Cerebral pressure autoregulation (AR) is a process by which blood flow is kept constant over a specific cerebral perfusion pressure (CPP) range. There have been a number of advances in recent years in the monitoring and modelling of this physiological variable; however, there has been very little work done on the comparison or optimisation of some of the existing models in clinical use today: pressure reactivity index, highest modal frequency techniques and compartmental modelling. Presented here is a methodology for the comparison and optimisation results for these main AR models. By simple mathematical manipulation of the original modelling end points each model can be converted into a form that is directly comparable to the others. Using a standardised data set with known gold standard AR status indications, the models can then be readily assessed. As a consequence each of the models can then be optimised to maximise specificity and sensitivity.