van Twist Eris, Robles Tahisa B, Formsma Bart, Ketharanathan Naomi, Hunfeld Maayke, Buysse C M, de Hoog Matthijs, Schouten Alfred C, de Jonge Rogier C J, Kuiper Jan W
Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands.
J Clin Monit Comput. 2025 Apr;39(2):291-299. doi: 10.1007/s10877-024-01248-w. Epub 2024 Dec 19.
This study aimed to develop an open-source algorithm for the pressure-reactivity index (PRx) to monitor cerebral autoregulation (CA) in pediatric severe traumatic brain injury (sTBI) and compared derived optimal cerebral perfusion pressure (CPPopt) with real-time CPP in relation to long-term outcome. Retrospective study in children (< 18 years) with sTBI admitted to the pediatric intensive care unit (PICU) for intracranial pressure (ICP) monitoring between 2016 and 2023. ICP was analyzed on an insult basis and correlated with outcome. PRx was calculated as Pearson correlation coefficient between ICP and mean arterial pressure. CPPopt was derived as weighted average of CPP-PRx over time. Outcome was determined via Pediatric Cerebral Performance Category (PCPC) scale at one year post-injury. Logistic regression and mixed effect models were developed to associate PRx and CPPopt with outcome. In total 50 children were included, 35 with favorable (PCPC 1-3) and 15 with unfavorable outcome (PCPC 4-6). ICP insults correlated with unfavorable outcome at 20 mmHg for 7 min duration. Mean CPPopt yield was 75.4% of monitoring time. Mean and median PRx and CPPopt yield associated with unfavorable outcome, with odds ratio (OR) 2.49 (1.38-4.50), 1.38 (1.08-1.76) and 0.95 (0.92-0.97) (p < 0.001). PRx thresholds 0.0, 0.20, 0.25 and 0.30 resulted in OR 1.01 (1.00-1.02) (p < 0.006). CPP in optimal range associated with unfavorable outcome on day one (0.018, p = 0.029) and four (-0.026, p = 0.025). Our algorithm can obtain optimal targets for pediatric neuromonitoring that showed association with long-term outcome, and is now available open source.
本研究旨在开发一种用于压力反应指数（PRx）的开源算法，以监测小儿重型颅脑损伤（sTBI）中的脑自动调节（CA），并将推导得出的最佳脑灌注压（CPPopt）与实时CPP进行比较，以探讨其与长期预后的关系。对2016年至2023年间因颅内压（ICP）监测而入住儿科重症监护病房（PICU）的小儿sTBI患儿（<18岁）进行回顾性研究。基于损伤情况分析ICP，并将其与预后相关联。PRx计算为ICP与平均动脉压之间的Pearson相关系数。CPPopt推导为CPP - PRx随时间的加权平均值。通过伤后一年的小儿脑功能表现类别（PCPC）量表确定预后。建立逻辑回归和混合效应模型，将PRx和CPPopt与预后相关联。共纳入50名儿童，其中35名预后良好（PCPC 1 - 3），15名预后不良（PCPC 4 - 6）。ICP损伤持续7分钟且达到20 mmHg时与不良预后相关。CPPopt平均产生时间占监测时间的75.4%。平均和中位数PRx及CPPopt产生时间与不良预后相关，优势比（OR）分别为2.49（1.38 - 4.50）、1.38（1.08 - 1.76）和0.95（0.92 - 0.97）（p < 0.001）。PRx阈值0.0、0.20、0.25和0.30对应的OR为1.01（1.00 - 1.02）（p < 0.006）。伤后第1天（0.018，p = 0.029）和第4天（-0.026，p = 0.025），处于最佳范围内的CPP与不良预后相关。我们的算法可以获得与小儿神经监测长期预后相关的最佳目标，并且现在已开源。
