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Towards autoregulation-oriented management after traumatic brain injury: increasing the reliability and stability of
Erta Beqiri1, Ari Ercole2, Marcel J H Aries3,4
1Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. vb391@cam.ac.uk.
Journal of Clinical Monitoring and Computing
|April 29, 2023
Summary
Optimizing Cerebral Perfusion Pressure (CPP) targets using the CPPopt algorithm improves stability and reliability for traumatic brain injury patients. This enhanced algorithm maintains prognostic power for predicting mortality in intensive care units.
Area of Science:
- Neuroscience
- Intensive Care Medicine
- Biomedical Engineering
Background:
- Cerebral Autoregulation (CA) is crucial for maintaining stable brain blood flow.
- Cerebral Perfusion Pressure (CPP) optimization aims to individualize CPP targets in traumatic brain injury (TBI).
- Automated CPPopt algorithms require validation for safe and reliable clinical application.
Purpose of the Study:
- To enhance the stability and reliability of the automated CPPopt algorithm through fine-tuning.
- To validate the performance of the adjusted CPPopt algorithm in a multi-center TBI cohort.
- To assess the prognostic power of CPPopt deviation for mortality prediction.
Main Methods:
- The ICM+ software was utilized for CPPopt derivation and algorithm refinement.
- Algorithm improvements were based on quantitative and qualitative assessments of stability and reliability metrics.
- Retrospective validation was performed on the high-resolution cohort from the CENTER-TBI study.
Main Results:
- The fine-tuned CPPopt algorithm demonstrated significantly higher stability (p < 0.0001) but a lower yield (80.5%) compared to the previous version (85%).
- Deviation of CPPopt effectively predicted 6-month mortality with an AUC of 0.69 (p < 0.001), comparable to the prior algorithm.
- The adjusted algorithm's prognostic power for mortality prediction was maintained.
Conclusions:
- The refined CPPopt calculation algorithm is suitable for prospective use.
- The updated algorithm offers improved stability and retains prognostic capabilities, despite a slight reduction in yield.
- This optimization enhances the reliability of individualized CPP targets in TBI management.
