Visualisation of the ‘optimal cerebral perfusion’ landscape in severe traumatic brain injury patients

Ari Ercole; Peter Smielewski; Marcel J.H. Aries; Robin Wesselink; Jan Willem J. Elting; Joseph Donnelly; Marek Czosnyka; Natasha M. Maurits

doi:10.1007/978-3-319-65798-1_12

Visualisation of the ‘optimal cerebral perfusion’ landscape in severe traumatic brain injury patients

Ari Ercole^*, Peter Smielewski, Marcel J.H. Aries, Robin Wesselink, Jan Willem J. Elting, Joseph Donnelly, Marek Czosnyka, Natasha M. Maurits

^*Corresponding author for this work

Technical Medicine

Research output: Chapter in Book/Report/Conference proceeding › Chapter › Academic › peer-review

6 Citations (Scopus)

21 Downloads (Pure)

Abstract

Objective: An ‘optimal’ cerebral perfusion pressure (CPPopt) can be defined as the point on the CPP scale corresponding to the greatest autoregulatory capacity. This can be established by examining the pressure reactivity index PRx–CPP relationship, which is approximately U-shaped but suffers from noise and missing data. In this paper, we present a method for plotting the whole PRx-CPP relationship curve against time in the form of a colour-coded map depicting the ‘landscape’ of that relationship extending back for several hours and to display this robustly at the bedside. This is a short version of a full paper recently published in Critical Care Medicine (2016) containing some new insights and details of a novel bedside implementation based on a presentation during Intracranial Pressure 2016 Symposium in Boston.

Methods: Recordings from routine monitoring of traumatic brain injury patients were processed using ICM+. Time-averaged means for arterial blood pressure, intracranial pressure, cerebral perfusion pressure (CPP) and pressure reactivity index (PRx) were calculated and stored with time resolution of 1 min. ICM+ functions have been extended to include not just an algorithm of automatic calculation of CPPopt but also the ‘CPPopt landscape’ chart.

Results: Examining the ‘CPPopt landscape’ allows the clinician to differentiate periods where the autoregulatory range is narrow and needs to be targeted from periods when the patient is generally haemodynamically stable, allowing for more relaxed CPP management. This information would not have been conveyed using the original visualisation approaches.

Conclusions: We describe here a natural extension to the concept of autoregulatory assessment, providing the retrospective ‘landscape’ of the PRx-CPP relationship extending over the past several hours. We have incorporated such visualisation techniques online in ICM+. The proposed visualisation may facilitate clinical evaluation and use of autoregulation-guided therapy.

Original language	English
Title of host publication	Intracranial Pressure & Neuromonitoring XVI
Editors	Thomas Heldt
Publisher	Springer
Pages	55-58
Number of pages	4
ISBN (Electronic)	978-3-319-65798-1
ISBN (Print)	978-3-319-65797-4, 978-3-319-88109-6
DOIs	https://doi.org/10.1007/978-3-319-65798-1_12
Publication status	Published - 2018
Event	16th International Conference on Intracranial Pressure and Neuromonitoring 2016 - Cambridge, United States Duration: 28 Jun 2016 → 2 Jul 2016 Conference number: 16

Publication series

Name	Acta Neurochirurgica, Supplementum
Volume	126
ISSN (Print)	0065-1419
ISSN (Electronic)	2197-8395

Conference

Conference	16th International Conference on Intracranial Pressure and Neuromonitoring 2016
Country/Territory	United States
City	Cambridge
Period	28/06/16 → 2/07/16

Keywords

Cerebral perfusion pressure
Optimal CPP
Pressure reactivity
PRx
Traumatic brain injury

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10.1007/978-3-319-65798-1_12

Ercole-2018-Visualisation-of-the-optimal-cerebrAccepted author version, 1.62 MB

Cite this

Ercole, A., Smielewski, P., Aries, M. J. H., Wesselink, R., Elting, J. W. J., Donnelly, J., Czosnyka, M., & Maurits, N. M. (2018). Visualisation of the ‘optimal cerebral perfusion’ landscape in severe traumatic brain injury patients. In T. Heldt (Ed.), Intracranial Pressure & Neuromonitoring XVI (pp. 55-58). (Acta Neurochirurgica, Supplementum; Vol. 126). Springer. https://doi.org/10.1007/978-3-319-65798-1_12

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abstract = "Objective: An {\textquoteleft}optimal{\textquoteright} cerebral perfusion pressure (CPPopt) can be defined as the point on the CPP scale corresponding to the greatest autoregulatory capacity. This can be established by examining the pressure reactivity index PRx–CPP relationship, which is approximately U-shaped but suffers from noise and missing data. In this paper, we present a method for plotting the whole PRx-CPP relationship curve against time in the form of a colour-coded map depicting the {\textquoteleft}landscape{\textquoteright} of that relationship extending back for several hours and to display this robustly at the bedside. This is a short version of a full paper recently published in Critical Care Medicine (2016) containing some new insights and details of a novel bedside implementation based on a presentation during Intracranial Pressure 2016 Symposium in Boston.Methods: Recordings from routine monitoring of traumatic brain injury patients were processed using ICM+. Time-averaged means for arterial blood pressure, intracranial pressure, cerebral perfusion pressure (CPP) and pressure reactivity index (PRx) were calculated and stored with time resolution of 1 min. ICM+ functions have been extended to include not just an algorithm of automatic calculation of CPPopt but also the {\textquoteleft}CPPopt landscape{\textquoteright} chart.Results: Examining the {\textquoteleft}CPPopt landscape{\textquoteright} allows the clinician to differentiate periods where the autoregulatory range is narrow and needs to be targeted from periods when the patient is generally haemodynamically stable, allowing for more relaxed CPP management. This information would not have been conveyed using the original visualisation approaches.Conclusions: We describe here a natural extension to the concept of autoregulatory assessment, providing the retrospective {\textquoteleft}landscape{\textquoteright} of the PRx-CPP relationship extending over the past several hours. We have incorporated such visualisation techniques online in ICM+. The proposed visualisation may facilitate clinical evaluation and use of autoregulation-guided therapy.",

keywords = "Cerebral perfusion pressure, Optimal CPP, Pressure reactivity, PRx, Traumatic brain injury",

author = "Ari Ercole and Peter Smielewski and Aries, {Marcel J.H.} and Robin Wesselink and Elting, {Jan Willem J.} and Joseph Donnelly and Marek Czosnyka and Maurits, {Natasha M.}",

note = "Publisher Copyright: {\textcopyright} Springer International Publishing AG 2018.; 16th International Conference on Intracranial Pressure and Neuromonitoring 2016 ; Conference date: 28-06-2016 Through 02-07-2016",

year = "2018",

doi = "10.1007/978-3-319-65798-1_12",

language = "English",

isbn = "978-3-319-65797-4",

series = "Acta Neurochirurgica, Supplementum",

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Ercole, A, Smielewski, P, Aries, MJH, Wesselink, R, Elting, JWJ, Donnelly, J, Czosnyka, M & Maurits, NM 2018, Visualisation of the ‘optimal cerebral perfusion’ landscape in severe traumatic brain injury patients. in T Heldt (ed.), Intracranial Pressure & Neuromonitoring XVI . Acta Neurochirurgica, Supplementum, vol. 126, Springer, pp. 55-58, 16th International Conference on Intracranial Pressure and Neuromonitoring 2016, Cambridge, Massachusetts, United States, 28/06/16. https://doi.org/10.1007/978-3-319-65798-1_12

Visualisation of the ‘optimal cerebral perfusion’ landscape in severe traumatic brain injury patients. / Ercole, Ari; Smielewski, Peter; Aries, Marcel J.H. et al.
Intracranial Pressure & Neuromonitoring XVI . ed. / Thomas Heldt. Springer, 2018. p. 55-58 (Acta Neurochirurgica, Supplementum; Vol. 126).

Research output: Chapter in Book/Report/Conference proceeding › Chapter › Academic › peer-review

TY - CHAP

T1 - Visualisation of the ‘optimal cerebral perfusion’ landscape in severe traumatic brain injury patients

AU - Ercole, Ari

AU - Smielewski, Peter

AU - Aries, Marcel J.H.

AU - Wesselink, Robin

AU - Elting, Jan Willem J.

AU - Donnelly, Joseph

AU - Czosnyka, Marek

AU - Maurits, Natasha M.

N1 - Conference code: 16

PY - 2018

Y1 - 2018

N2 - Objective: An ‘optimal’ cerebral perfusion pressure (CPPopt) can be defined as the point on the CPP scale corresponding to the greatest autoregulatory capacity. This can be established by examining the pressure reactivity index PRx–CPP relationship, which is approximately U-shaped but suffers from noise and missing data. In this paper, we present a method for plotting the whole PRx-CPP relationship curve against time in the form of a colour-coded map depicting the ‘landscape’ of that relationship extending back for several hours and to display this robustly at the bedside. This is a short version of a full paper recently published in Critical Care Medicine (2016) containing some new insights and details of a novel bedside implementation based on a presentation during Intracranial Pressure 2016 Symposium in Boston.Methods: Recordings from routine monitoring of traumatic brain injury patients were processed using ICM+. Time-averaged means for arterial blood pressure, intracranial pressure, cerebral perfusion pressure (CPP) and pressure reactivity index (PRx) were calculated and stored with time resolution of 1 min. ICM+ functions have been extended to include not just an algorithm of automatic calculation of CPPopt but also the ‘CPPopt landscape’ chart.Results: Examining the ‘CPPopt landscape’ allows the clinician to differentiate periods where the autoregulatory range is narrow and needs to be targeted from periods when the patient is generally haemodynamically stable, allowing for more relaxed CPP management. This information would not have been conveyed using the original visualisation approaches.Conclusions: We describe here a natural extension to the concept of autoregulatory assessment, providing the retrospective ‘landscape’ of the PRx-CPP relationship extending over the past several hours. We have incorporated such visualisation techniques online in ICM+. The proposed visualisation may facilitate clinical evaluation and use of autoregulation-guided therapy.

AB - Objective: An ‘optimal’ cerebral perfusion pressure (CPPopt) can be defined as the point on the CPP scale corresponding to the greatest autoregulatory capacity. This can be established by examining the pressure reactivity index PRx–CPP relationship, which is approximately U-shaped but suffers from noise and missing data. In this paper, we present a method for plotting the whole PRx-CPP relationship curve against time in the form of a colour-coded map depicting the ‘landscape’ of that relationship extending back for several hours and to display this robustly at the bedside. This is a short version of a full paper recently published in Critical Care Medicine (2016) containing some new insights and details of a novel bedside implementation based on a presentation during Intracranial Pressure 2016 Symposium in Boston.Methods: Recordings from routine monitoring of traumatic brain injury patients were processed using ICM+. Time-averaged means for arterial blood pressure, intracranial pressure, cerebral perfusion pressure (CPP) and pressure reactivity index (PRx) were calculated and stored with time resolution of 1 min. ICM+ functions have been extended to include not just an algorithm of automatic calculation of CPPopt but also the ‘CPPopt landscape’ chart.Results: Examining the ‘CPPopt landscape’ allows the clinician to differentiate periods where the autoregulatory range is narrow and needs to be targeted from periods when the patient is generally haemodynamically stable, allowing for more relaxed CPP management. This information would not have been conveyed using the original visualisation approaches.Conclusions: We describe here a natural extension to the concept of autoregulatory assessment, providing the retrospective ‘landscape’ of the PRx-CPP relationship extending over the past several hours. We have incorporated such visualisation techniques online in ICM+. The proposed visualisation may facilitate clinical evaluation and use of autoregulation-guided therapy.

KW - Cerebral perfusion pressure

KW - Optimal CPP

KW - Pressure reactivity

KW - PRx

KW - Traumatic brain injury

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DO - 10.1007/978-3-319-65798-1_12

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Y2 - 28 June 2016 through 2 July 2016

ER -

Visualisation of the ‘optimal cerebral perfusion’ landscape in severe traumatic brain injury patients

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