Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use: A Validation Study

Erta Beqiri; Ari Ercole; Marcel J Aries; Manuel Cabeleira; Andras Czigler; Annalisa Liberti; Jeanette Tas; Joseph Donnelly; Xiuyun Liu; Marta Fedriga; Ka Hing Chu; Frederick A Zeiler; Marek Czosnyka; Peter Smielewski

doi:10.1007/978-3-030-59436-7_36

Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use: A Validation Study

Erta Beqiri, Ari Ercole, Marcel J Aries, Manuel Cabeleira, Andras Czigler, Annalisa Liberti, Jeanette Tas, Joseph Donnelly, Xiuyun Liu, Marta Fedriga, Ka Hing Chu, Frederick A Zeiler, Marek Czosnyka, Peter Smielewski

Research output: Chapter in Book/Report/Conference proceeding › Chapter › Academic

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Abstract

BACKGROUND: Pressure reactivity index (PRx)-cerebral perfusion pressure (CPP) relationships over a given time period can be used to detect a value of CPP at which PRx shows the best autoregulation (optimal CPP, or CPPopt). Algorithms for continuous assessment of CPPopt in traumatic brain injury (TBI) patients reached the desired high yield with a multi-window approach (CPPopt_MA). However, the calculations were tested on retrospective manually cleaned datasets. Moreover, CPPopt false-positive values can be generated from non-physiological variations of intracranial pressure (ICP) and arterial blood pressure (ABP). Therefore, the algorithm robustness was improved, making it suitable for prospective bedside application (COGiTATE trial).

OBJECTIVE: To validate the CPPopt revised algorithm in a large single-centre retrospective cohort of TBI patients.

METHODS: 840 TBI patients were included. CPPopt yield, stability and ability to discriminate outcome groups were compared to CPPopt_MA and the Brain Trauma Foundation (BTF) guideline reference.

RESULTS: CPPopt yield was lower than CPPopt_MA yield (85% and 90%, p < 0.001), but, importantly, with increased stability (p < 0.0001). The ∆(CPP-CPPopt) could distinguish the mortality and survival outcome (t = -6.7, p < 0.0001) with a statistical significance higher than the ∆CPP calculated with the guideline reference (CPP-60) (t = -4.5, p < 0.0001).

CONCLUSION: This study validates, on a large cohort of patients, the new algorithm proposed for prospective use of CPPopt as a CPP target at bedside.

Original language	English
Title of host publication	Intracranial Pressure and Neuromonitoring XVII
Editors	Bart Depreitere, Geert Meyfroidt, Fabian Güiza
Publisher	Springer, Cham
Pages	181-185
Number of pages	5
Volume	131
ISBN (Electronic)	978-3-030-59436-7
ISBN (Print)	978-3-030-59435-0
DOIs	https://doi.org/10.1007/978-3-030-59436-7_36
Publication status	Published - 2021

Publication series

Series	Acta Neurochirurgica, Supplement
ISSN	0065-1419

Keywords

Brain Injuries, Traumatic
Cerebrovascular Circulation
Humans
Intracranial Pressure
Prospective Studies
Retrospective Studies

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Cite this

Beqiri, E., Ercole, A., Aries, M. J., Cabeleira, M., Czigler, A., Liberti, A., Tas, J., Donnelly, J., Liu, X., Fedriga, M., Chu, K. H., Zeiler, F. A., Czosnyka, M., & Smielewski, P. (2021). Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use: A Validation Study. In B. Depreitere, G. Meyfroidt, & F. Güiza (Eds.), Intracranial Pressure and Neuromonitoring XVII (Vol. 131, pp. 181-185). Springer, Cham. https://doi.org/10.1007/978-3-030-59436-7_36

Beqiri, Erta ; Ercole, Ari ; Aries, Marcel J et al. / Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use : A Validation Study. Intracranial Pressure and Neuromonitoring XVII. editor / Bart Depreitere ; Geert Meyfroidt ; Fabian Güiza. Vol. 131 Springer, Cham, 2021. pp. 181-185 (Acta Neurochirurgica, Supplement).

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abstract = "BACKGROUND: Pressure reactivity index (PRx)-cerebral perfusion pressure (CPP) relationships over a given time period can be used to detect a value of CPP at which PRx shows the best autoregulation (optimal CPP, or CPPopt). Algorithms for continuous assessment of CPPopt in traumatic brain injury (TBI) patients reached the desired high yield with a multi-window approach (CPPopt_MA). However, the calculations were tested on retrospective manually cleaned datasets. Moreover, CPPopt false-positive values can be generated from non-physiological variations of intracranial pressure (ICP) and arterial blood pressure (ABP). Therefore, the algorithm robustness was improved, making it suitable for prospective bedside application (COGiTATE trial).OBJECTIVE: To validate the CPPopt revised algorithm in a large single-centre retrospective cohort of TBI patients.METHODS: 840 TBI patients were included. CPPopt yield, stability and ability to discriminate outcome groups were compared to CPPopt_MA and the Brain Trauma Foundation (BTF) guideline reference.RESULTS: CPPopt yield was lower than CPPopt_MA yield (85% and 90%, p < 0.001), but, importantly, with increased stability (p < 0.0001). The ∆(CPP-CPPopt) could distinguish the mortality and survival outcome (t = -6.7, p < 0.0001) with a statistical significance higher than the ∆CPP calculated with the guideline reference (CPP-60) (t = -4.5, p < 0.0001).CONCLUSION: This study validates, on a large cohort of patients, the new algorithm proposed for prospective use of CPPopt as a CPP target at bedside.",

keywords = "Brain Injuries, Traumatic, Cerebrovascular Circulation, Humans, Intracranial Pressure, Prospective Studies, Retrospective Studies",

author = "Erta Beqiri and Ari Ercole and Aries, {Marcel J} and Manuel Cabeleira and Andras Czigler and Annalisa Liberti and Jeanette Tas and Joseph Donnelly and Xiuyun Liu and Marta Fedriga and Chu, {Ka Hing} and Zeiler, {Frederick A} and Marek Czosnyka and Peter Smielewski",

note = "Funding Information: Acknowledgement MC is supported by NIHR Cambridge Biomedical Funding Information: MC is supported by NIHR Cambridge Biomedical Research Centre. The authors would also like to express their gratitude to all doctors and nursing staff of the Neuro Critical Care Unit of Addenbrooke?s Hospital, Cambridge, UK, for their professional help and support in computer-bedside data monitoring conducted by the Brain Physics Laboratory team. Publisher Copyright: {\textcopyright} 2021, Springer Nature Switzerland AG.",

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Beqiri, E, Ercole, A, Aries, MJ, Cabeleira, M, Czigler, A, Liberti, A, Tas, J, Donnelly, J, Liu, X, Fedriga, M, Chu, KH, Zeiler, FA, Czosnyka, M & Smielewski, P 2021, Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use: A Validation Study. in B Depreitere, G Meyfroidt & F Güiza (eds), Intracranial Pressure and Neuromonitoring XVII. vol. 131, Springer, Cham, Acta Neurochirurgica, Supplement, pp. 181-185. https://doi.org/10.1007/978-3-030-59436-7_36

Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use: A Validation Study. / Beqiri, Erta; Ercole, Ari; Aries, Marcel J et al.
Intracranial Pressure and Neuromonitoring XVII. ed. / Bart Depreitere; Geert Meyfroidt; Fabian Güiza. Vol. 131 Springer, Cham, 2021. p. 181-185 (Acta Neurochirurgica, Supplement).

Research output: Chapter in Book/Report/Conference proceeding › Chapter › Academic

TY - CHAP

T1 - Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use

T2 - A Validation Study

AU - Beqiri, Erta

AU - Ercole, Ari

AU - Aries, Marcel J

AU - Cabeleira, Manuel

AU - Czigler, Andras

AU - Liberti, Annalisa

AU - Tas, Jeanette

AU - Donnelly, Joseph

AU - Liu, Xiuyun

AU - Fedriga, Marta

AU - Chu, Ka Hing

AU - Zeiler, Frederick A

AU - Czosnyka, Marek

AU - Smielewski, Peter

N1 - Funding Information: Acknowledgement MC is supported by NIHR Cambridge Biomedical Funding Information: MC is supported by NIHR Cambridge Biomedical Research Centre. The authors would also like to express their gratitude to all doctors and nursing staff of the Neuro Critical Care Unit of Addenbrooke?s Hospital, Cambridge, UK, for their professional help and support in computer-bedside data monitoring conducted by the Brain Physics Laboratory team. Publisher Copyright: © 2021, Springer Nature Switzerland AG.

PY - 2021

Y1 - 2021

N2 - BACKGROUND: Pressure reactivity index (PRx)-cerebral perfusion pressure (CPP) relationships over a given time period can be used to detect a value of CPP at which PRx shows the best autoregulation (optimal CPP, or CPPopt). Algorithms for continuous assessment of CPPopt in traumatic brain injury (TBI) patients reached the desired high yield with a multi-window approach (CPPopt_MA). However, the calculations were tested on retrospective manually cleaned datasets. Moreover, CPPopt false-positive values can be generated from non-physiological variations of intracranial pressure (ICP) and arterial blood pressure (ABP). Therefore, the algorithm robustness was improved, making it suitable for prospective bedside application (COGiTATE trial).OBJECTIVE: To validate the CPPopt revised algorithm in a large single-centre retrospective cohort of TBI patients.METHODS: 840 TBI patients were included. CPPopt yield, stability and ability to discriminate outcome groups were compared to CPPopt_MA and the Brain Trauma Foundation (BTF) guideline reference.RESULTS: CPPopt yield was lower than CPPopt_MA yield (85% and 90%, p < 0.001), but, importantly, with increased stability (p < 0.0001). The ∆(CPP-CPPopt) could distinguish the mortality and survival outcome (t = -6.7, p < 0.0001) with a statistical significance higher than the ∆CPP calculated with the guideline reference (CPP-60) (t = -4.5, p < 0.0001).CONCLUSION: This study validates, on a large cohort of patients, the new algorithm proposed for prospective use of CPPopt as a CPP target at bedside.

AB - BACKGROUND: Pressure reactivity index (PRx)-cerebral perfusion pressure (CPP) relationships over a given time period can be used to detect a value of CPP at which PRx shows the best autoregulation (optimal CPP, or CPPopt). Algorithms for continuous assessment of CPPopt in traumatic brain injury (TBI) patients reached the desired high yield with a multi-window approach (CPPopt_MA). However, the calculations were tested on retrospective manually cleaned datasets. Moreover, CPPopt false-positive values can be generated from non-physiological variations of intracranial pressure (ICP) and arterial blood pressure (ABP). Therefore, the algorithm robustness was improved, making it suitable for prospective bedside application (COGiTATE trial).OBJECTIVE: To validate the CPPopt revised algorithm in a large single-centre retrospective cohort of TBI patients.METHODS: 840 TBI patients were included. CPPopt yield, stability and ability to discriminate outcome groups were compared to CPPopt_MA and the Brain Trauma Foundation (BTF) guideline reference.RESULTS: CPPopt yield was lower than CPPopt_MA yield (85% and 90%, p < 0.001), but, importantly, with increased stability (p < 0.0001). The ∆(CPP-CPPopt) could distinguish the mortality and survival outcome (t = -6.7, p < 0.0001) with a statistical significance higher than the ∆CPP calculated with the guideline reference (CPP-60) (t = -4.5, p < 0.0001).CONCLUSION: This study validates, on a large cohort of patients, the new algorithm proposed for prospective use of CPPopt as a CPP target at bedside.

KW - Brain Injuries, Traumatic

KW - Cerebrovascular Circulation

KW - Humans

KW - Intracranial Pressure

KW - Prospective Studies

KW - Retrospective Studies

U2 - 10.1007/978-3-030-59436-7_36

DO - 10.1007/978-3-030-59436-7_36

M3 - Chapter

C2 - 33839842

SN - 978-3-030-59435-0

VL - 131

T3 - Acta Neurochirurgica, Supplement

SP - 181

EP - 185

BT - Intracranial Pressure and Neuromonitoring XVII

A2 - Depreitere, Bart

A2 - Meyfroidt, Geert

A2 - Güiza, Fabian

PB - Springer, Cham

ER -

Beqiri E, Ercole A, Aries MJ, Cabeleira M, Czigler A, Liberti A et al. Optimal Cerebral Perfusion Pressure Assessed with a Multi-Window Weighted Approach Adapted for Prospective Use: A Validation Study. In Depreitere B, Meyfroidt G, Güiza F, editors, Intracranial Pressure and Neuromonitoring XVII. Vol. 131. Springer, Cham. 2021. p. 181-185. (Acta Neurochirurgica, Supplement). doi: 10.1007/978-3-030-59436-7_36