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Published on: October 17, 2017
An open source autoregulation-based neuromonitoring algorithm shows PRx and optimal CPP association with pediatric
Eris van Twist1, Tahisa B Robles2, Bart Formsma2
1Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands. e.vantwist@erasmusmc.nl.
An open-source algorithm for pressure-reactivity index (PRx) aids in monitoring cerebral autoregulation (CA) in pediatric severe traumatic brain injury (sTBI). This tool helps identify optimal cerebral perfusion pressure (CPPopt) targets, improving long-term outcomes in children.
Area of Science:
- Neuroscience
- Pediatric Critical Care
- Biomedical Engineering
Background:
- Pediatric severe traumatic brain injury (sTBI) poses significant challenges in neuromonitoring.
- Cerebral autoregulation (CA) is crucial for maintaining adequate cerebral blood flow in pediatric patients.
- Current methods for monitoring CA and optimizing cerebral perfusion pressure (CPP) in children have limitations.
Purpose of the Study:
- To develop and validate an open-source algorithm for calculating the pressure-reactivity index (PRx).
- To assess the utility of the derived optimal cerebral perfusion pressure (CPPopt) in relation to real-time CPP and long-term outcomes in pediatric sTBI.
- To provide a novel, accessible tool for pediatric neuromonitoring.
Main Methods:
- Retrospective analysis of intracranial pressure (ICP) and mean arterial pressure data from pediatric patients (<18 years) with sTBI.
- Calculation of PRx using Pearson correlation between ICP and mean arterial pressure.
- Derivation of CPPopt as a weighted average of CPP-PRx over time.
- Correlation of PRx and CPPopt with one-year outcomes using logistic regression and mixed-effect models.
Main Results:
- The developed algorithm successfully derived CPPopt for a significant portion of monitoring time (75.4%).
- Elevated PRx and suboptimal CPPopt were significantly associated with unfavorable long-term outcomes (PCPC 4-6).
- Specific PRx thresholds demonstrated a clear correlation with adverse outcomes, indicating their predictive value.
Conclusions:
- The open-source PRx algorithm provides a valuable tool for monitoring CA in pediatric sTBI.
- Derived CPPopt targets are associated with long-term neurological outcomes in this population.
- This algorithm offers a promising approach for optimizing neuromonitoring and improving patient management in pediatric neurocritical care.
