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Journal of Clinical Monitoring and Computing
Published in: Journal of Clinical Monitoring and Computing 4/2021

Open Access 01-08-2021 | Central Nervous System Trauma | Original Research

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

Authors: Frederick A. Zeiler, Manuel Cabeleira, Peter J. Hutchinson, Nino Stocchetti, Marek Czosnyka, Peter Smielewski, Ari Ercole, the CENTER-TBI High-Resolution ICU (HR ICU) Sub-Study Participants and Investigators

Published in: Journal of Clinical Monitoring and Computing | Issue 4/2021

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Abstract

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.
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Metadata
Title
Evaluation of the relationship between slow-waves of intracranial pressure, mean arterial pressure and brain tissue oxygen in TBI: a CENTER-TBI exploratory analysis
Authors
Frederick A. Zeiler
Manuel Cabeleira
Peter J. Hutchinson
Nino Stocchetti
Marek Czosnyka
Peter Smielewski
Ari Ercole
the CENTER-TBI High-Resolution ICU (HR ICU) Sub-Study Participants and Investigators
Publication date
01-08-2021
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 4/2021
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-020-00527-6

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