Abstract
In patients with severe traumatic brain injury (TBI), simultaneous measurement of intracranial and arterial blood pressure (ICP and ABP, respectively) allows monitoring of cerebral perfusion pressure (CPP) and the assessment of cerebral autoregulation (CA). CPP, a difference between ICP and ABP, is the pressure gradient that drives oxygen delivery to cerebral tissue. CA is the ability of cerebral vasculature to maintain stable blood flow despite changes in CPP and thus, is an important homeostatic mechanism. Pressure reactivity index (PRx), a moving Pearson’s correlation between slow waves in ICP and ABP, has been most frequently cited in literature over the past two decades as a tool for CA evaluation. However, in some clinical situations, ICP monitoring may be unavailable or contraindicated. In such cases, simultaneous mean arterial pressure (MAP) monitoring and near-infrared spectroscopy (NIRS) can be used for CA assessment by cerebral oximetry index (COx), allowing calculation of the optimal blood pressure (MAPOPT). The purpose of this study was to compare regional oxygen saturation (rSO2)-based CA (COx) with ICP/ABP-based CA (PRx) in TBI patients and to compare MAPOPT derived from both technologies. Three TBI patients were monitored at the bedside to measure CA using both PRx and COx. Patients were monitored daily for up to 3 days from TBI. Averaged PRx and COx-, and PRx and COx-based MAPOPT were compared using Pearson’s correlation. Bias analysis was performed between these same CA metrics. Correlation between averaged values of COx and PRx was R = 0.35, p = 0.15. Correlation between optimal MAP calculated for COx and PRx was R = 0.49, p < 0.038. Bland–Altman analysis showed moderate agreement with a bias of 0.16 ± 0.23 for COx versus PRx and good agreement with a bias of 0.39 ± 7.89 for optimal MAP determined by COx versus PRx. Non-invasive measurement of CA by NIRS (COx) is not correlated with invasive ICP/ABP-based CA (PRx). However, the determination of MAPOPT using COx is correlated with MAPOPT derived from PRx. Obtained results demonstrate that COx is not an acceptable substitute for PRx in TBI patients. However, in some TBI cases, NIRS may be useful in determining MAP determination.
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References
Czosnyka M, Miller C, Le Roux P et al (2014) Participants in the international multidisciplinary consensus conference on multimodality monitoring. Monitoring of cerebral autoregulation. Neurocrit Care Suppl 2:S95–S102
Rosner MJ, Daughton S (1990) Cerebral perfusion pressure management in head injury. J Trauma 30:933–940
Lassen NA (1964) Autoregulation of cerebral blood flow. Circ Res 15(SUPPL):201–204
Zeiler FA, Donnelly J, Calviello L et al (2017) Pressure autoregulation measurement techniques in adult traumatic brain injury, part II: a sco** review of continuous methods. J Neurotrauma 34(23):3224–3237
Depreitere B, Citerio G, Smith M et al (2021) Cerebrovascular autoregulation monitoring in the management of adult severe traumatic brain injury: a Delphi consensus of clinicians. Neurocrit Care 34(3):731–738
Czosnyka M, Brady K, Reinhard M et al (2009) Monitoring of cerebrovascular autoregulation: facts, myths, and missing links. Neurocrit Care 10(3):373–386
Czosnyka M, Smielewski P, Kirkpatrick P et al (1997) Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery 41(1):11–17
Brady KM, Lee JK, Kibler KK et al (2007) Continuous time-domain analysis of cerebrovascular autoregulation using near-infrared spectroscopy. Stroke 38:2818–2825
Rivera-Lara L, Geocadin R, Zorrilla-Vaca A et al (2017) Validation of near-infrared spectroscopy for monitoring cerebral autoregulation in comatose patients. Neurocrit Care 27(3):362–369
Brain Trauma Foundation, American Association of Neurological Surgeons (2007) Guidelines for the management of severe traumatic brain injury. J Neurotrauma 24(Suppl 1):S1–S106
Smielewski P, Czosnyka M, Steiner L et al (2005) ICM+: software for on-line analysis of bedside monitoring data after severe head trauma. Acta Neurochir Suppl 95:43–49
Marshall LF, Marshall SB, Klauber MR (1991) A new classification of head injury based on computerized tomography. J Neurosurg 75(Special Supplements):S14–S20
Stocchetti N, Picetti E, Berardino M et al (2014) Clinical applications of intracranial pressure monitoring in traumatic brain injury: report of the Milan consensus conference. Acta Neurochir 156(8):1615–1622
Steiner LA, Czosnyka M, Piechnik SK et al (2002) Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med 30(4):733–738
Aries MJ, Czosnyka M, Budohoski KP (2012) Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med 40(8):2456–2463
Sekhon MS, Gooderham P, Menon DK et al (2019) The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest. Crit Care Med 47(7):960–969
Tas J, Beqiri E, van Kaam CR et al (2021) An update on the COGiTATE phase II study: feasibility and safety of targeting an optimal cerebral perfusion pressure as a patient-tailored therapy in severe traumatic brain injury. Acta Neurochir Suppl 131:143–147
Liu X, Hu X, Brady KM et al (2020) Comparison of wavelet and correlation indices of cerebral autoregulation in a pediatric swine model of cardiac arrest. Sci Rep 10(1):5926
Brady KM, Easley RB, Kibler K et al (2012) Positive end-expiratory pressure oscillation facilitates brain vascular reactivity monitoring. J Appl Physiol 113(9):1362–1368
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DB was supported by NIH R01 NS112808.
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Oshorov, A., Savin, I., Alexandrova, E., Bragin, D. (2022). Assessment of Optimal Arterial Pressure with Near-Infrared Spectroscopy in Traumatic Brain Injury Patients. In: Scholkmann, F., LaManna, J., Wolf, U. (eds) Oxygen Transport to Tissue XLIII. Advances in Experimental Medicine and Biology, vol 1395. Springer, Cham. https://doi.org/10.1007/978-3-031-14190-4_23
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