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Evaluation of the relationship between slow-waves of intracranial pressure, mean arterial pressure and brain tissue oxygen in TBI: a CENTER-TBI exploratory analysis.

Authors
  • Zeiler, Frederick A1, 2, 3, 4, 5
  • Cabeleira, Manuel6
  • Hutchinson, Peter J7
  • Stocchetti, Nino8, 9
  • Czosnyka, Marek6, 10
  • Smielewski, Peter6
  • Ercole, Ari11
  • 1 Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. [email protected]
  • 2 Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada. [email protected] , (Canada)
  • 3 Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. [email protected] , (Canada)
  • 4 Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Canada. [email protected] , (Canada)
  • 5 Centre on Aging, University of Manitoba, Winnipeg, Canada. [email protected] , (Canada)
  • 6 Brain Physics Laboratory, Division of Neurosurgery, Dept of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK.
  • 7 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK.
  • 8 Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. , (Italy)
  • 9 Department of Physiopathology and Transplantation, Milan University, Milan, Italy. , (Italy)
  • 10 Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland. , (Poland)
  • 11 Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Type
Published Article
Journal
Journal of clinical monitoring and computing
Publication Date
Aug 01, 2021
Volume
35
Issue
4
Pages
711–722
Identifiers
DOI: 10.1007/s10877-020-00527-6
PMID: 32418148
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Brain tissue oxygen (PbtO2) monitoring in traumatic brain injury (TBI) has demonstrated strong associations with global outcome. Additionally, PbtO2 signals have been used to derive indices thought to be associated with cerebrovascular reactivity in TBI. However, their true relationship to slow-wave vasogenic fluctuations associated with cerebral autoregulation remains unclear. The goal of this study was to investigate the relationship between slow-wave fluctuations of intracranial pressure (ICP), mean arterial pressure (MAP) and PbtO2 over time. Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) high resolution ICU sub-study cohort, we evaluated those patients with recorded high-frequency digital intra-parenchymal ICP and PbtO2 monitoring data of a minimum of 6 h in duration. Digital physiologic signals were processed for ICP, MAP, and PbtO2 slow-waves using a moving average filter to decimate the high-frequency signal. The first 5 days of recording were analyzed. The relationship between ICP, MAP and PbtO2 slow-waves over time were assessed using autoregressive integrative moving average (ARIMA) and vector autoregressive integrative moving average (VARIMA) modelling, as well as Granger causality testing. A total of 47 patients were included. The ARIMA structure of ICP and MAP were similar in time, where PbtO2 displayed different optimal structure. VARIMA modelling and IRF plots confirmed the strong directional relationship between MAP and ICP, demonstrating an ICP response to MAP impulse. PbtO2 slow-waves, however, failed to demonstrate a definite response to ICP and MAP slow-wave impulses. These results raise questions as to the utility of PbtO2 in the derivation of cerebrovascular reactivity measures in TBI. There is a reproducible relationship between slow-wave fluctuations of ICP and MAP, as demonstrated across various time-series analytic techniques. PbtO2 does not appear to reliably respond in time to slow-wave fluctuations in MAP, as demonstrated on various VARIMA models across all patients. These findings suggest that PbtO2 should not be utilized in the derivation of cerebrovascular reactivity metrics in TBI, as it does not appear to be responsive to changes in MAP in the slow-waves. These findings corroborate previous results regarding PbtO2 based cerebrovascular reactivity indices. © 2020. The Author(s).

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