Trending autoregulatory indices during treatment for traumatic brain injury.
Our goal is to use automatic data monitoring for reliable prediction of episodes of intracranial hypertension in patients with traumatic brain injury. Here we test the validity of our method on retrospective patient data. We developed the Continuous Hemodynamic Autoregulatory Monitor (CHARM), that siphons and stores signals from existing monitors in the surgical intensive care unit (SICU), efficiently compresses them, and standardizes the search for statistical relationships between any proposed index and adverse events. CHARM uses an automated event detector to reliably locate episodes of elevated intracranial pressure (ICP), while eliminating artifacts within retrospective patient data. A graphical user interface allowed data scanning, selection of criteria for events, and calculating indices. The pressure reactivity index (PRx), defined as the least square linear regression slope of intracranial pressure versus arterial BP, was calculated for a single case that spanned 259 h. CHARM collected continuous records of ABP, ICP, ECG, SpO2, and ventilation from 29 patients with TBI over an 18-month period. Analysis of a single patient showed that PRx data distribution in the single hours immediately prior to all 16 intracranial hypertensive events, significantly differed from that in the 243 h that did not precede such events (p < 0.0001). The PRx index, however, lacked sufficient resolution as a real-time predictor of IH in this patient. CHARM streamlines the search for reliable predictors of intracranial hypertension. We report statistical evidence supporting the predictive potential of the pressure reactivity index.
['Kim|Nam|N|', 'Krasner|Alex|A|', 'Kosinski|Colin|C|', 'Wininger|Michael|M|', 'Qadri|Maria|M|', 'Kappus|Zachary|Z|', 'Danish|Shabbar|S|', 'Craelius|William|W|']
D016477:Artifacts D001331:Automation D000070642:Brain Injuries, Traumatic D002560:Cerebrovascular Circulation D003196:Computer Graphics D001330:Electronic Data Processing D006439:Hemodynamics D006801:Humans D007362:Intensive Care Units D019586:Intracranial Hypertension D007427:Intracranial Pressure D016018:Least-Squares Analysis D016014:Linear Models D008490:Medical Informatics D008991:Monitoring, Physiologic D012189:Retrospective Studies D012815:Signal Processing, Computer-Assisted
Traumatic brain injury ICP PRx ABP TBI Autoregulation Informatics SICU