Exploration of uncertainty of PRx time trends

Erta Beqiri; Michal M Placek; Ka Hing Chu; Joseph Donnelly; Giada Cucciolini; Virginia Motroni; Claudia A Smith; Marek Czosnyka; Peter Hutchinson; Peter Smielewski

doi:10.1016/j.bas.2024.102795

Exploration of uncertainty of PRx time trends

Brain Spine. 2024 Mar 31:4:102795. doi: 10.1016/j.bas.2024.102795. eCollection 2024.

Authors

Erta Beqiri¹, Michal M Placek^{1

2}, Ka Hing Chu¹, Joseph Donnelly^{1

3}, Giada Cucciolini^{1

2

3

4}, Virginia Motroni¹, Claudia A Smith¹, Marek Czosnyka¹, Peter Hutchinson^{1

2}, Peter Smielewski¹

Affiliations

¹ Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom.
² Neurosurgery Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³ Department of Medicine, University of Auckland, New Zealand.
⁴ Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.

Abstract

Introduction: PRx can be used as surrogate measure of Cerebral Autoregulation (CA) in traumatic brain injury (TBI) patients. PRx can provide means for individualising cerebral perfusion pressure (CPP) targets, such as CPPopt. However, a recent Delphi consensus of clinicians concluded that consensus could not be reached on the accuracy, reliability, and validation of any current CA assessment method.

Research question: We aimed to quantify the short-term uncertainty of PRx time-trends and to relate this to other physiological measurements.

Material and methods: Intracranial pressure (ICP), arterial blood pressure (ABP), end-tidal CO₂ (EtCO₂) high-resolution recordings of 911 TBI patients were processed with ICM + software. Hourly values of metrics that describe the variability within modalities derived from ABP, ICP and EtCO₂, were calculated for the first 24h of neuromonitoring. Generalized additive models were used to describe the time trend of the variability in PRx. Linear correlations were studied for describing the relationship between PRx variability and the other physiological modalities.

Results: The time profile of variability of PRx decreases over the first 12h and was higher for average PRx ∼0. Increased variability of PRx was not linearly linked with average ABP, ICP, or CPP. For coherence between slow waves of ABP and ICP >0.7, the variability in PRx decreased (R = -0.47, p < 0.001).

Discussion and conclusion: PRx is a highly variable parameter. PRx short-term dispersion was not related to average ICP, ABP or CPP. The determinants of uncertainty of PRx should be investigated to improve reliability of individualised CA assessment in TBI patients.

Keywords: Cerebral autoregulation; PRx; Time-trends; Traumatic brain injury; Uncertainty; Variability.