Towards autoregulation-oriented management after traumatic brain injury: increasing the reliability and stability of the CPPopt algorithm

• DOI: 10.1007/s10877-023-01009-1
• Publication Date: 2023-04-29T05:01:41Z
• Authors: Erta Beqiri; Ari Ercole; Marcel J. H. Aries; Michal M. Placek; Jeanette Tas; Marek Czosnyka; Nino Stocchetti; Peter Smielewski; ; Audny Anke; Ronny Beer; Bo-Michael Bellander; Erta Beqiri; Andras Buki; Manuel Cabeleira; Marco Carbonara; Arturo Chieregato; Giuseppe Citerio; Hans Clusmann; Endre Czeiter; Marek Czosnyka; Bart Depreitere; Ari Ercole; Shirin Frisvold; Raimund Helbok; Stefan Jankowski; Daniel Kondziella; Lars-Owe Koskinen; Ana Kowark; David K. Menon; Geert Meyfroidt; Kirsten Moeller; David Nelson; Anna Piippo-Karja...; Andreea Radoi; Arminas Ragauskas; Rahul Raj; Jonathan Rhodes; Saulius Rocka; Rolf Rossaint; Juan Sahuquillo; Oliver Sakowitz; Peter Smielewski; Nino Stocchetti; Nina Sundström; Riikka Takala; Tomas Tamosuitis; Olli Tenovuo; Andreas Unterberg; Peter Vajkoczy; Alessia Vargiolu; Rimantas Vilcinis; Stefan Wolf; Alexander Younsi; Frederick A. Zeiler
• Keywords: Cerebral autoregulation; CPPopt; Multiwindow weighted approach; Reliability; Stability; Traumatic brain injury; cerebral autoregulation; Intracranial Pressure; Traumatic brain injury; multiwindow weighted approach; Brain Injuries, Traumatic; Humans; Homeostasis; Cerebral autoregulation; CPPopt; Multiwindow weighted approach; Reliability; Stability; Traumatic brain injury;; Original Research; Retrospective Studies; CPPopt; reliability; MONITORING DATA; CPPopt ; cerebral autoregulation ; traumatic brain injury ; reliability ; stability ; multiwindow weighted approach; traumatic brain injury; Reproducibility of Results; stability; Reliability; REACTIVITY; Cerebral autoregulation; CEREBRAL PERFUSION-PRESSURE; Cerebrovascular Circulation; Multiwindow weighted approach; Stability; Algorithms

CPPopt denotes a Cerebral Perfusion Pressure (CPP) value at which the Pressure-Reactivity index, reflecting global state of Autoregulation, is best preserved. has been investigated as potential dynamically individualised CPP target in traumatic brain injury patients admitted intensive care unit. The prospective bedside use concept requires ensured safety and reliability recommended targets based on automatically-generated CPPopt. We aimed to: Increase stability automated algorithm by fine-tuning; perform outcome validation adjusted multi-centre TBI cohort.ICM + software was used to derive fine-tune algorithm. Parameters for improvement were selected qualitative quantitative assessment metrics. Patients enrolled Collaborative European Neuro Trauma Effectiveness Research (CENTER-TBI) high-resolution cohort included retrospective validation. Yield new compared previous using Mann-U test. Area under curves mortality prediction 6 months with DeLong Test.CPPopt showed higher (p < 0.0001), but lower yield [80.5% (70-87.5) vs 85% (75.7-91.2), p 0.001]. Deviation could predict an AUC [AUC = 0.69 (95% CI 0.59-0.78), 0.001] comparable algorithm.The calculation fine-tuned adapted acceptable yield, improved maintained prognostic power.