1. A noninvasive estimation of cerebral perfusion pressure using critical closing pressure
- Author
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Varsos, Georgios V, Kolias, Angelos G, Smielewski, Peter, Brady, Ken M, Varsos, Vassilis G, Hutchinson, Peter J, Pickard, John D, Czosnyka, Marek, Kolias, Angelos [0000-0003-3992-0587], Smielewski, Peter [0000-0001-5096-3938], Hutchinson, Peter [0000-0002-2796-1835], Pickard, John [0000-0002-5762-6667], Czosnyka, Marek [0000-0003-2446-8006], and Apollo - University of Cambridge Repository
- Subjects
MCA = middle cerebral artery ,Adult ,Male ,FV = flow velocity ,noninvasive model ,AUC = area under the curve ,Adolescent ,Intracranial Pressure ,Ultrasonography, Doppler, Transcranial ,Blood Pressure ,nICP = noninvasive estimator of ICP ,vascular disorders ,Sensitivity and Specificity ,Young Adult ,Craniocerebral Trauma ,Humans ,eCPP = noninvasive estimator of CPP ,GOS = Glasgow Outcome Scale ,CrCP = critical closing pressure ,Monitoring, Physiologic ,Retrospective Studies ,cerebral perfusion pressure ,CBF = cerebral blood flow ,ICP = intracranial pressure ,TAU = time constant of the cerebrovascular arterial bed ,CVR = cerebrovascular resistance ,TCD = transcranial Doppler ,GCS = Glasgow Coma Scale ,Middle Aged ,critical closing pressure ,ROC = receiver operating characteristic ,ABP = arterial blood pressure ,CPP = cerebral perfusion pressure ,Cerebrovascular Circulation ,transcranial Doppler ultrasonography ,Female ,TBI = traumatic brain injury ,Blood Flow Velocity ,IQR = interquartile range - Abstract
OBJECT: Cerebral blood flow is associated with cerebral perfusion pressure (CPP), which is clinically monitored through arterial blood pressure (ABP) and invasive measurements of intracranial pressure (ICP). Based on critical closing pressure (CrCP), the authors introduce a novel method for a noninvasive estimator of CPP (eCPP). METHODS: Data from 280 head-injured patients with ABP, ICP, and transcranial Doppler ultrasonography measurements were retrospectively examined. CrCP was calculated with a noninvasive version of the cerebrovascular impedance method. The eCPP was refined with a predictive regression model of CrCP-based estimation of ICP from known ICP using data from 232 patients, and validated with data from the remaining 48 patients. RESULTS: Cohort analysis showed eCPP to be correlated with measured CPP (R = 0.851, p < 0.001), with a mean ± SD difference of 4.02 ± 6.01 mm Hg, and 83.3% of the cases with an estimation error below 10 mm Hg. eCPP accurately predicted low CPP (< 70 mm Hg) with an area under the curve of 0.913 (95% CI 0.883-0.944). When each recording session of a patient was assessed individually, eCPP could predict CPP with a 95% CI of the SD for estimating CPP between multiple recording sessions of 1.89-5.01 mm Hg. CONCLUSIONS: Overall, CrCP-based eCPP was strongly correlated with invasive CPP, with sensitivity and specificity for detection of low CPP that show promise for clinical use.
- Published
- 2015