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

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 adm...

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Bibliographic Details
Published in:Journal of clinical monitoring and computing Vol. 37; no. 4; pp. 963 - 976
Main Authors: Beqiri, Erta, Ercole, Ari, Aries, Marcel J. H., Placek, Michal M., Tas, Jeanette, Czosnyka, Marek, Stocchetti, Nino, Smielewski, Peter
Format: Journal Article
Language:English
Published: Dordrecht Springer Netherlands 01.08.2023
Springer Nature B.V
Subjects:
Algorithms
Anesthesiology
Brain
Brain Injuries, Traumatic - therapy
Cerebrovascular Circulation - physiology
Critical Care Medicine
Head injuries
Health Sciences
Homeostasis - physiology
Humans
Intensive
Intracranial Pressure - physiology
Medicine
Medicine & Public Health
Mortality
Original Research
Reliability
Reproducibility of Results
Retrospective Studies
Stability analysis
Statistics for Life Sciences
Traumatic brain injury
CPPopt
Cerebral autoregulation
Traumatic brain injury
Stability
Reliability
Multiwindow weighted approach
ISSN:1387-1307, 1573-2614, 1573-2614
Online Access:Get full text
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Summary: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.
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ISSN:1387-1307
1573-2614
1573-2614
DOI:10.1007/s10877-023-01009-1