Bonfanti Marco, Lorini Ferdinando Luca, Zangari Rosalia, Bonanomi Ezio, Farina Alessia, Pezzetti Giulio, Gerevini Simonetta, Aresi Silvia, Dell'Avanzo Giacomo, Micheli Fabio, Lanterna Luigi Andrea, Biroli Francesco, Gritti Paolo
FROM Research Foundation- ETS, Papa Giovanni XXIII Hospital, Piazza OSM 1, 24129, Bergamo, Italy.
Department of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Neurocrit Care. 2025 Feb;42(1):152-163. doi: 10.1007/s12028-024-02056-5. Epub 2024 Jul 15.
The study investigated the effectiveness of low-frequency sampling in detecting alterations in cerebrovascular reactivity (CVR) associated with changes in intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across different age groups. The primary objective was to investigate an ICP threshold that indicates a decrease in CVR as evidenced by a significant increase in the ultra-low-frequency pressure reactivity index (UL-PRx). Additionally, the study aimed to develop an age-based categorization method for patients with TBI to investigate the differences between these ICP thresholds in different age groups.
In this retrospective analysis, data from 263 patients with TBI were prospectively collected. ICP and mean arterial pressure were extracted from the hospital database at 5-min intervals. Demographic details, clinical presentation, computed tomography scans, neurosurgical interventions, and 12-months outcome were recorded. ICP versus UL-PRx values were categorized into ICP bins and graphically represented with boxplots for each age group, illustrating how as ICP values rise, there is a bin (age-tailored ICP [AT-ICP]) beyond which UL-PRx shows a sudden increase, indicating CVR loss. Homogeneous age groups were established to obtain a consistent AT-ICP threshold. The discriminatory ability of the AT-ICP thresholds was compared with the guideline-recommended thresholds by calculating the area under the Receiver Operating Characteristic curve of the ICP-derived indices (dose above threshold, and the hourly dosage above threshold).
Age groups 0-5, 6-20, 21-60, 61-70, and 71-85 years were the best age subdivisions, corresponding to AT-ICP thresholds of 20, 30, 35, 25, and 30 mmHg, respectively. The AT-ICP thresholds exhibited better discriminative ability compared with the guideline-recommended thresholds.
The AT-ICP thresholds offer a novel approach for estimating CVR impairment and the developed method represents an alternative solution to address the age stratification issue in patients with TBI.
本研究调查了低频采样在检测不同年龄组创伤性脑损伤（TBI）患者中与颅内压（ICP）变化相关的脑血管反应性（CVR）改变方面的有效性。主要目的是研究一个ICP阈值，该阈值表明CVR降低，这可通过超低频压力反应性指数（UL-PRx）的显著增加来证明。此外，该研究旨在为TBI患者开发一种基于年龄的分类方法，以研究不同年龄组中这些ICP阈值之间的差异。
在这项回顾性分析中，前瞻性收集了263例TBI患者的数据。每隔5分钟从医院数据库中提取ICP和平均动脉压。记录人口统计学细节、临床表现、计算机断层扫描、神经外科干预措施以及12个月的预后情况。将ICP与UL-PRx值分类到ICP区间，并为每个年龄组用箱线图进行图形表示，说明随着ICP值升高，存在一个区间（年龄定制ICP [AT-ICP]），超过该区间UL-PRx会突然增加，表明CVR丧失。建立同质年龄组以获得一致的AT-ICP阈值。通过计算ICP衍生指数（阈值以上剂量和每小时阈值以上剂量）的受试者工作特征曲线下面积，将AT-ICP阈值的判别能力与指南推荐的阈值进行比较。
0至5岁、6至20岁、21至60岁、61至70岁和71至85岁年龄组是最佳年龄细分，分别对应于20、30、35、25和30 mmHg的AT-ICP阈值。与指南推荐的阈值相比，AT-ICP阈值表现出更好的判别能力。
AT-ICP阈值为估计CVR损伤提供了一种新方法，并且所开发的方法代表了解决TBI患者年龄分层问题的另一种方案。
