Monitoring of Optimal Cerebral Perfusion Pressure in Traumatic Brain Injured Patients Using a Multi-Window Weighting Algorithm

Xiuyun Liu, Natasha M. Maurits, Marcel J.H. Aries, Marek Czosnyka, Ari Ercole, Joseph Donnelly, Danilo Cardim, Dong Ju Kim, Celeste Dias, Manuel Cabeleira, Peter Smielewski

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13 Citations (Scopus)

Abstract

Methods to identify an autoregulation guided "optimal" cerebral perfusion pressure (CPPopt) for traumatic brain injury patients (TBI) have been reported through several studies. An important drawback of existing methodology is that CPPopt can be calculated only in ∼50-60% of the monitoring time. In this study, we hypothesized that the CPPopt yield and the continuity can be improved significantly through application of a multi-window and weighting calculation algorithm, without adversely affecting preservation of its prognostic value. Data of 526 severe TBI patients admitted between 2003 and 2015 were studied. The multi-window CPPopt calculation was based on automated curve fitting in pressure reactivity index (PRx)-CPP plots using data from 36 increasing length time windows (2-8 h). The resulting matrix of CPPopts was then averaged in a weighted manner. The yield, continuity, and stability of CPPopt were studied. The difference between patients' actual CPP and CPPopt (ΔCPP) was calculated and the association with outcome was analyzed. Overall, the multi-window method demonstrated more continuous and stable presentation of CPPopt in this cohort. The new method resulted in a mean (±SE) CPPopt yield of 94% ± 2.1%, as opposed to the previous single-window-based CPPopt yield of 51% ± 0.94%. The stability of CPPopt across the whole monitoring period was significantly improved by using the new algorithm (p < 0.001). The relationship between ΔCPP according to the multi-window algorithm and outcome was similar to that for CPPopt calculated on the basis of a single window. In conclusion, this study validates the use of a new multi-window and weighting algorithm for significant improvement of CPPopt yield in TBI patients. This methodological improvement is essential for its clinical application in future CPPopt trials.

Original languageEnglish
Pages (from-to)3081-3088
Number of pages8
JournalJournal of Neurotrauma
Volume34
Issue number22
DOIs
Publication statusPublished - 2017 Nov 15

Keywords

  • CPPopt
  • TBI
  • cerebral autoregulation
  • multi-window algorithm
  • pressure reactivity index

ASJC Scopus subject areas

  • Clinical Neurology

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    Liu, X., Maurits, N. M., Aries, M. J. H., Czosnyka, M., Ercole, A., Donnelly, J., Cardim, D., Kim, D. J., Dias, C., Cabeleira, M., & Smielewski, P. (2017). Monitoring of Optimal Cerebral Perfusion Pressure in Traumatic Brain Injured Patients Using a Multi-Window Weighting Algorithm. Journal of Neurotrauma, 34(22), 3081-3088. https://doi.org/10.1089/neu.2017.5003