Department of Anesthesia and Critical Care Medicine, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Crit Care. 2024 Jan 23;28(1):33. doi: 10.1186/s13054-024-04814-5.
The ultra-low-frequency pressure reactivity index (UL-PRx) has been established as a surrogate method for bedside estimation of cerebral autoregulation (CA). Although this index has been shown to be a predictor of outcome in adult and pediatric patients with traumatic brain injury (TBI), a comprehensive evaluation of low sampling rate data collection (0.0033 Hz averaged over 5 min) on cerebrovascular reactivity has never been performed.
To evaluate the performance and predictive power of the UL-PRx for 12-month outcome measures, alongside all International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) models and in different age groups. To investigate the potential for optimal cerebral perfusion pressure (CPPopt).
Demographic data, IMPACT variables, in-hospital mortality, and Glasgow Outcome Scale Extended (GOSE) at 12 months were extracted. Filtering and processing of the time series and creation of the indices (cerebral intracranial pressure (ICP), cerebral perfusion pressure (CPP), UL-PRx, and deltaCPPopt (ΔCPPopt and CPPopt-CPP)) were performed using an in-house algorithm. Physiological parameters were assessed as follows: mean index value, % time above threshold, and mean hourly dose above threshold.
A total of 263 TBI patients were included: pediatric (17.5% aged ≤ 16 y) and adult (60.5% aged > 16 and < 70 y and 22.0% ≥ 70 y, respectively) patients. In-hospital and 12-month mortality were 25.9% and 32.7%, respectively, and 60.0% of patients had an unfavorable outcome at 12 months (GOSE). On univariate analysis, ICP, CPP, UL-PRx, and ΔCPPopt were associated with 12-month outcomes. The cutoff of ~ 20-22 for mean ICP and of ~ 0.30 for mean UL-PRx were confirmed in all age groups, except in patients older than 70 years. Mean UL-PRx remained significantly associated with 12-month outcomes even after adjustment for IMPACT models. This association was confirmed in all age groups. UL-PRx resulted associate with CPPopt.
The study highlights UL-PRx as a tool for assessing CA and valuable outcome predictor for TBI patients. The results emphasize the potential clinical utility of the UL-PRx and its adaptability across different age groups, even after adjustment for IMPACT models. Furthermore, the correlation between UL-PRx and CPPopt suggests the potential for more targeted treatment strategies.
ClinicalTrials.gov identifier: NCT05043545, principal investigator Paolo Gritti, date of registration 2021.08.21.
超低频率压力反应指数（UL-PRx）已被确立为一种替代方法，用于床边估计脑自动调节（CA）。尽管该指数已被证明是创伤性脑损伤（TBI）的成年和儿科患者的预后预测指标，但从未对脑血管反应的低采样率数据采集（0.0033 Hz 平均 5 分钟）进行全面评估。
评估 UL-PRx 在 12 个月的预后指标方面的性能和预测能力，以及所有国际预后和分析临床试验任务（IMPACT）模型，并在不同年龄组中进行评估。研究潜在的最佳脑灌注压（CPPopt）。
提取人口统计学数据、IMPACT 变量、住院死亡率和 12 个月时的格拉斯哥预后量表扩展（GOSE）。使用内部算法对时间序列进行滤波和处理，并创建指数（脑颅内压（ICP）、脑灌注压（CPP）、UL-PRx 和 deltaCPPopt（ΔCPPopt 和 CPPopt-CPP））。评估生理参数如下：平均指数值、超过阈值的%时间和平均每小时超过阈值的剂量。
共纳入 263 例 TBI 患者：儿科（17.5%年龄≤16 岁）和成年（60.5%年龄>16 岁和<70 岁，22.0%年龄≥70 岁）患者。住院和 12 个月的死亡率分别为 25.9%和 32.7%，12 个月时 60.0%的患者预后不良（GOSE）。单因素分析显示，ICP、CPP、UL-PRx 和 ΔCPPopt 与 12 个月的预后相关。在所有年龄组中，除了年龄大于 70 岁的患者外，平均 ICP 的截断值约为 20-22，平均 UL-PRx 的截断值约为 0.30。在调整了 IMPACT 模型后，平均 UL-PRx 仍然与 12 个月的预后显著相关。这一关联在所有年龄组中均得到证实。UL-PRx 与 CPPopt 相关。
本研究强调了 UL-PRx 作为评估 CA 和 TBI 患者预后有价值的预测指标的工具。研究结果强调了 UL-PRx 的潜在临床应用价值及其在不同年龄组中的适应性，甚至在调整了 IMPACT 模型后也是如此。此外，UL-PRx 和 CPPopt 之间的相关性表明，可能需要更有针对性的治疗策略。
ClinicalTrials.gov 标识符：NCT05043545，主要研究者 Paolo Gritti，注册日期 2021.08.21。
