Towards autoregulation-oriented management after traumatic brain injury: increasing the reliability and stability of the CPPopt algorithm

Erta Beqiri*, Ari Ercole, Marcel J. H. Aries, Michal Placek, Jeanette Tas, Marek Czosnyka, Nino A. Stocchetti, Peter Smielewski, CENTER-TBI High Resolution (HR ICU) Sub-Study Participants and Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: CPPopt denotes a Cerebral Perfusion Pressure (CPP) value at which the Pressure-Reactivity index, reflecting the global state of Cerebral Autoregulation, is best preserved. CPPopt has been investigated as a potential dynamically individualised CPP target in traumatic brain injury patients admitted in intensive care unit. The prospective bedside use of the concept requires ensured safety and reliability of the CPP recommended targets based on the automatically-generated CPPopt. We aimed to: Increase stability and reliability of the CPPopt automated algorithm by fine-tuning; perform outcome validation of the adjusted algorithm in a multi-centre TBI cohort. Methods: ICM + software was used to derive CPPopt and fine-tune the algorithm. Parameters for improvement of the algorithm were selected based on qualitative and quantitative assessment of stability and reliability metrics. Patients enrolled in the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution cohort were included for retrospective validation. Yield and stability of the new algorithm were compared to the previous algorithm using Mann–U test. Area under the curves for mortality prediction at 6 months were compared with the DeLong Test. Results: CPPopt showed higher stability (p < 0.0001), but lower yield compared to the previous algorithm [80.5% (70—87.5) vs 85% (75.7—91.2), p < 0.001]. Deviation of CPPopt could predict mortality with an AUC of [AUC = 0.69 (95% CI 0.59–0.78), p < 0.001] and was comparable with the previous algorithm. Conclusion: The CPPopt calculation algorithm was fine-tuned and adapted for prospective use with acceptable lower yield, improved stability and maintained prognostic power.

Original languageEnglish
Pages (from-to)963-976
Number of pages14
JournalJournal of Clinical Monitoring and Computing
Volume37
Issue number4
Early online date1 Apr 2023
DOIs
Publication statusPublished - Aug 2023

Keywords

  • CPPopt
  • Cerebral autoregulation
  • Traumatic brain injury
  • Reliability
  • Stability
  • Multiwindow weighted approach
  • CEREBRAL PERFUSION-PRESSURE
  • MONITORING DATA
  • REACTIVITY

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