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

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Dokumenter

  • the CENTER-TBI High-Resolution ICU (HR ICU) Sub-Study Participants and Investigators

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.

OriginalsprogEngelsk
TidsskriftJournal of Clinical Monitoring and Computing
Vol/bind35
Udgave nummer4
Sider (fra-til)711-722
Antal sider12
ISSN1387-1307
DOI
StatusUdgivet - aug. 2021

Bibliografisk note

Funding Information:
FAZ receives research support from the Manitoba Public Insurance (MPI) Neuroscience/TBI Research Endowment, the United States National Institutes of Health (NIH) through the National Institute of Neurological Disorders and Stroke (NINDS), the Canadian Institutes for Health Research (CIHR), the Canadian Foundation for Innovation (CFI), the University of Manitoba Centre on Aging, the University of Manitoba VPRI Research Investment Fund (RIF), the University of Manitoba Rudy Falk Clinician-Scientist Professorship, and the Health Sciences Centre Foundation Winnipeg. MC is supported by NIHR Cambridge BRC. PH is supported by the NIHR (Research Professorship, Cambridge BRC, Global Health Research Group on Neurotrauma) and the Royal College of Surgeons of England. Acknowledgements CENTER-TBI High Resolution Sub-Study Participants and Investigators

Publisher Copyright:
© 2020, The Author(s).

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