Association Between the Cerebral Autoregulation Index (Pressure Reactivity), Patient's Clinical Outcome, and Quality of ABP(t) and ICP(t) Signals for CA Monitoring.
Background and Objectives: The aim of this study was to explore the association between the cerebral autoregulation (CA) index, the pressure reactivity index (PRx), the patient's clinical outcome, and the quality of arterial blood pressure (ABP(t)) and intracranial blood pressure (ICP(t)) signals by comparing two filtering methods to derive the PRx. Materials and Methods: Data from 60 traumatic brain injury (TBI) patients were collected. Moving averaging and FIR (Finite Impulse Response) filtering were performed on the ABP(t) and ICP(t) signals, and the PRx was estimated from both filtered datasets. Sensitivity, specificity, and receiver-operating characteristic (ROC) curves with the area under the curves (AUCs) were determined using patient outcomes as a reference. The outcome chosen for comparison among the two filtering methods were mortality and survival. Results: The FIR filtering approach, compared with clinical outcome, had a sensitivity of 70%, a specificity of 81%, and a level of significance p = 0.001 with an area under the curve (AUC) of 0.78. The moving average filtering method compared with the clinical outcome had a sensitivity of 58%, a specificity of 72%, and a level of significance p = 0.054, with an area under the curve (AUC) of 0.66. Conclusions: The FIR (optimal) filtering approach was found to be more sensitive for discriminating between two clinical outcomes, namely intact (survival) and impaired (death) cerebral autoregulation for TBI treatment decision making.
['Bajpai|Basant K|BK|0000-0002-7035-8740', 'Preiksaitis|Aidanas|A|', 'Vosylius|Saulius|S|', 'Rocka|Saulius|S|']
D000328:Adult D001794:Blood Pressure D001795:Blood Pressure Determination D000070642:Brain Injuries, Traumatic D002560:Cerebrovascular Circulation D005260:Female D006706:Homeostasis D006801:Humans D007427:Intracranial Pressure D008297:Male D063868:Patient Outcome Assessment D012189:Retrospective Studies D012680:Sensitivity and Specificity D016019:Survival Analysis
pressure reactivity index arterial blood pressure traumatic brain injury receiver-operating characteristic area under the curve cerebral blood flow cerebral perfusion pressure cerebrovascular autoregulation intracranial pressure