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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| Vydáno v: | Journal of clinical monitoring and computing Ročník 37; číslo 4; s. 963 - 976 |
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| Hlavní autoři: | , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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Dordrecht
Springer Netherlands
01.08.2023
Springer Nature B.V |
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| ISSN: | 1387-1307, 1573-2614, 1573-2614 |
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| Abstract | 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. |
|---|---|
| AbstractList | 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. 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. 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. 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. The CPPopt calculation algorithm was fine-tuned and adapted for prospective use with acceptable lower yield, improved stability and maintained prognostic power. PurposeCPPopt 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.MethodsICM + 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.ResultsCPPopt 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.ConclusionThe CPPopt calculation algorithm was fine-tuned and adapted for prospective use with acceptable lower yield, improved stability and maintained prognostic power. 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.PURPOSECPPopt 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.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.METHODSICM + 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.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.RESULTSCPPopt 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.The CPPopt calculation algorithm was fine-tuned and adapted for prospective use with acceptable lower yield, improved stability and maintained prognostic power.CONCLUSIONThe CPPopt calculation algorithm was fine-tuned and adapted for prospective use with acceptable lower yield, improved stability and maintained prognostic power. |
| Author | Beqiri, Erta Placek, Michal M. Ercole, Ari Tas, Jeanette Stocchetti, Nino Aries, Marcel J. H. Smielewski, Peter Czosnyka, Marek |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37119323$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Contributor | Nelson, David Cabeleira, Manuel Radoi, Andreea Takala, Riikka Vilcinis, Rimantas Frisvold, Shirin Ragauskas, Arminas Moeller, Kirsten Kowark, Ana Carbonara, Marco Wolf, Stefan Raj, Rahul Beqiri, Erta Sakowitz, Oliver Clusmann, Hans Younsi, Alexander Helbok, Raimund Tenovuo, Olli Piippo-Karjalainen, Anna Rocka, Saulius Smielewski, Peter Beer, Ronny Rhodes, Jonathan Sundström, Nina Vajkoczy, Peter Anke, Audny Rossaint, Rolf Vargiolu, Alessia Buki, Andras Menon, David K Chieregato, Arturo Czeiter, Endre Depreitere, Bart Unterberg, Andreas Czosnyka, Marek Koskinen, Lars-Owe Bellander, Bo-Michael Zeiler, Frederick A Ercole, Ari Jankowski, Stefan Stocchetti, Nino Sahuquillo, Juan Kondziella, Daniel Meyfroidt, Geert Tamosuitis, Tomas Citerio, Giuseppe |
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| CorporateAuthor | CENTER-TBI High Resolution (HR ICU) Sub-Study Participants and Investigators |
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| DOI | 10.1007/s10877-023-01009-1 |
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| Issue | 4 |
| Keywords | CPPopt Cerebral autoregulation Traumatic brain injury Stability Reliability Multiwindow weighted approach |
| Language | English |
| License | 2023. The Author(s). Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
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| PublicationTitle | Journal of clinical monitoring and computing |
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| PublicationYear | 2023 |
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| References | Cabeleira, Czosnyka, Liu, Donnelly, Smielewski (CR14) 2018; Supplement 126 Liberti (CR24) 2021 Maas (CR19) 2015; 76 Steiner (CR4) 2002; 30 Brassard (CR2) 2021 Liu (CR7) 2017; 34 Aries (CR6) 2012; 17 Depreitere (CR25) 2021 Beqiri (CR16) 2019 Zeiler (CR20) 2019; 1 Riemann (CR10) 2020 Kelly, Bishop, Ercole (CR13) 2018; Supplement 126 Maas (CR18) 2015; 76 Aries (CR17) 2012 Czosnyka, Smielewski, Kirkpatrick, Laing, Menon, Pickard (CR3) 1997; 41 Smielewski, Czosnyka, Steiner, Belestri, Piechnik, Pickard (CR12) 2005; 95 Schreiber, Schmitz (CR15) 2000; 142 CR9 Tas (CR8) 2021 CR23 CR22 Czosnyka (CR5) 1996; 27 Zeiler (CR21) 2019; 161 Lassen (CR1) 2019; 15 Depreitere (CR11) 2014; 120 MJH Aries (1009_CR17) 2012 AIR Maas (1009_CR18) 2015; 76 B Depreitere (1009_CR25) 2021 M Cabeleira (1009_CR14) 2018; Supplement 126 B Depreitere (1009_CR11) 2014; 120 FA Zeiler (1009_CR20) 2019; 1 P Smielewski (1009_CR12) 2005; 95 M Czosnyka (1009_CR5) 1996; 27 FA Zeiler (1009_CR21) 2019; 161 M Czosnyka (1009_CR3) 1997; 41 X Liu (1009_CR7) 2017; 34 T Schreiber (1009_CR15) 2000; 142 NA Lassen (1009_CR1) 2019; 15 E Beqiri (1009_CR16) 2019 P Brassard (1009_CR2) 2021 AIR Maas (1009_CR19) 2015; 76 S Kelly (1009_CR13) 2018; Supplement 126 LA Steiner (1009_CR4) 2002; 30 1009_CR9 L Riemann (1009_CR10) 2020 A Liberti (1009_CR24) 2021 J Tas (1009_CR8) 2021 MJH Aries (1009_CR6) 2012; 17 1009_CR23 1009_CR22 |
| References_xml | – start-page: 167 year: 2021 end-page: 172 ident: CR24 publication-title: Patient’s clinical presentation and CPPopt availability: any association? – ident: CR22 – year: 2021 ident: CR8 article-title: Targeting autoregulation-guided cerebral perfusion pressure after traumatic brain injury (COGiTATE): a feasibility randomized controlled clinical trial publication-title: J Neurotrauma doi: 10.1089/NEU.2021.0197 – volume: 142 start-page: 346 issue: 3–4 year: 2000 end-page: 382 ident: CR15 article-title: Surrogate time series publication-title: Physica D doi: 10.1016/S0167-2789(00)00043-9 – volume: 76 start-page: 67 issue: 1 year: 2015 end-page: 80 ident: CR19 article-title: Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): a prospective longitudinal observational study publication-title: Neurosurgery doi: 10.1227/NEU.0000000000000575 – year: 2021 ident: CR25 article-title: Cerebrovascular autoregulation monitoring in the management of adult severe traumatic brain injury: a Delphi consensus of clinicians publication-title: Neurocrit. Care doi: 10.1007/s12028-020-01185-x – volume: 27 start-page: 1829 issue: 10 year: 1996 end-page: 1834 ident: CR5 article-title: Monitoring of cerebral autoregulation in head-injured patients publication-title: Stroke doi: 10.1161/01.str.27.10.1829 – year: 2019 ident: CR16 article-title: Feasibility of individualised severe traumatic brain injury management using an automated assessment of optimal cerebral perfusion pressure: The COGiTATE phase II study protocol publication-title: BMJ Open doi: 10.1136/bmjopen-2019-030727 – volume: 41 start-page: 11 issue: 1 year: 1997 end-page: 7 ident: CR3 article-title: Continuous assessment of the cerebral vasomotor reactivity in head injury publication-title: Neurosurgery doi: 10.1097/00006123-199707000-00005 – volume: 95 start-page: 43 year: 2005 end-page: 9 ident: CR12 article-title: ICM+: software for on-line analysis of bedside monitoring data after severe head trauma publication-title: Acta Neurochir Suppl doi: 10.1007/3-211-32318-X_10 – volume: 17 start-page: 67 issue: 1 year: 2012 end-page: 76 ident: CR6 article-title: Continuous monitoring of cerebrovascular reactivity using pulse waveform of intracranial pressure publication-title: Neurocrit Care doi: 10.1007/s12028-012-9687-z – year: 2020 ident: CR10 article-title: Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: a CENTER-TBI study publication-title: Crit Care doi: 10.1186/s13054-020-02974-8 – volume: 76 start-page: 67 issue: 1 year: 2015 end-page: 80 ident: CR18 article-title: Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) publication-title: Neurosurgery doi: 10.1227/NEU.0000000000000575 – volume: 120 start-page: 1451 issue: 120 year: 2014 end-page: 1457 ident: CR11 article-title: Pressure autoregulation monitoring and cerebral perfusion pressure target recommendation in patients with severe traumatic brain injury based on minute-by-minute monitoring data publication-title: J Neurosurg doi: 10.3171/2014.3.JNS131500 – volume: 1 start-page: 10 year: 2019 ident: CR20 article-title: Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study publication-title: Acta Neurochir. doi: 10.1007/s00701-019-03915-3 – ident: CR23 – volume: 30 start-page: 733 issue: 4 year: 2002 end-page: 738 ident: CR4 article-title: Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury publication-title: Crit Care Med doi: 10.1097/00003246-200204000-00002 – ident: CR9 – year: 2012 ident: CR17 article-title: Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury* publication-title: Crit Care Med doi: 10.1097/CCM.0b013e3182514eb6 – volume: Supplement 126 start-page: 317 year: 2018 end-page: 320 ident: CR13 article-title: Statistical signal properties of the pressure-reactivity index (PRx) publication-title: Acta Neurochir – year: 2021 ident: CR2 article-title: Losing the dogmatic view of cerebral autoregulation publication-title: Physiol Rep doi: 10.14814/PHY2.14982 – volume: 34 start-page: 3081 issue: 22 year: 2017 end-page: 3088 ident: CR7 article-title: Monitoring of Optimal Cerebral Perfusion Pressure in Traumatic Brain Injured Patients Using a Multi-Window Weighting Algorithm publication-title: J Neurotrauma doi: 10.1089/neu.2017.5003 – volume: 161 start-page: 1955 year: 2019 end-page: 1964 ident: CR21 article-title: Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis High Resolution ICU (HR ICU) Sub-Study Participants and Investigators publication-title: Acta Neurochir (Wien) doi: 10.1007/s00701-019-03980-8 – volume: Supplement 126 start-page: 143 year: 2018 end-page: 146 ident: CR14 article-title: Occurrence of CPPopt values in uncorrelated ICP and ABP time series publication-title: Acta Neurochir – volume: 15 start-page: 201 year: 2019 end-page: 4 ident: CR1 article-title: Autoregulation of cerebral blood flow publication-title: Circ Res – volume: 41 start-page: 11 issue: 1 year: 1997 ident: 1009_CR3 publication-title: Neurosurgery doi: 10.1097/00006123-199707000-00005 – ident: 1009_CR22 doi: 10.1093/ije/dyx180 – ident: 1009_CR9 doi: 10.1007/978-3-030-59436-7_36 – volume: Supplement 126 start-page: 317 year: 2018 ident: 1009_CR13 publication-title: Acta Neurochir – year: 2021 ident: 1009_CR25 publication-title: Neurocrit. 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CPPopt denotes a Cerebral Perfusion Pressure (CPP) value at which the Pressure-Reactivity index, reflecting the global state of Cerebral... CPPopt denotes a Cerebral Perfusion Pressure (CPP) value at which the Pressure-Reactivity index, reflecting the global state of Cerebral Autoregulation, is... PurposeCPPopt denotes a Cerebral Perfusion Pressure (CPP) value at which the Pressure-Reactivity index, reflecting the global state of Cerebral Autoregulation,... |
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| SubjectTerms | 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 |
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| Title | Towards autoregulation-oriented management after traumatic brain injury: increasing the reliability and stability of the CPPopt algorithm |
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