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27.02.2023 | Original Article - Pediatric Neurosurgery

Evaluation and application of ultra-low-frequency pressure reactivity index in pediatric traumatic brain injury patients

verfasst von: Paolo Gritti, Marco Bonfanti, Rosalia Zangari, Ezio Bonanomi, Isabella Pellicioli, Pietro Mandelli, Luca Longhi, Frank A. Rasulo, Rita Bertuetti, Alessia Farina, Francesco Biroli, Ferdinando Luca Lorini

Erschienen in: Acta Neurochirurgica | Ausgabe 4/2023

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Abstract

Purpose

While clinical practice suggests that knowing the cerebral autoregulation (CA) status of traumatic brain injury (TBI) patients is crucial in assessing the best treatment, evidence in pediatric TBI (pTBI) is limited. The pressure reactivity index (PRx) is a surrogate method for the continuous estimation of CA in adults; however, calculations require continuous, high-resolution monitoring data. We evaluate an ultra-low-frequency pressure reactivity index (UL-PRx), based on data sampled at ∼5-min periods, and test its association with 6-month mortality and unfavorable outcome in a cohort of pTBI patients.

Methods

Data derived from pTBI patients (0–18 years) requiring intracranial pressure (ICP) monitoring were retrospectively collected and processed in MATLAB using an in-house algorithm.

Results

Data on 47 pTBI patients were included. UL-PRx mean values, ICP, cerebral perfusion pressure (CPP), and derived indices showed significant association with 6-month mortality and unfavorable outcome. A value of UL-PRx of 0.30 was identified as the threshold to better discriminate both surviving vs deceased patients (AUC: 0.90), and favorable vs unfavorable outcomes (AUC: 0.70) at 6 months. At multivariate analysis, mean UL-PRx and % time with ICP > 20 mmHg, remained significantly associated with 6-month mortality and unfavorable outcome, even when adjusted for International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT)-Core variables.

In six patients undergoing secondary decompressive craniectomy, no significant changes in UL-PRx were found after surgery.

Conclusions

UL-PRx is associated with a 6-month outcome even if adjusted for IMPACT-Core. Its application in pediatric intensive care unit could be useful to evaluate CA and offer possible prognostic and therapeutic implications in pTBI patients.

ClinicalTrials.gov

NCT05043545, September 14, 2021, retrospectively registered.

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Titel: Evaluation and application of ultra-low-frequency pressure reactivity index in pediatric traumatic brain injury patients
verfasst von: Paolo Gritti
Marco Bonfanti
Rosalia Zangari
Ezio Bonanomi
Isabella Pellicioli
Pietro Mandelli
Luca Longhi
Frank A. Rasulo
Rita Bertuetti
Alessia Farina
Francesco Biroli
Ferdinando Luca Lorini
Publikationsdatum: 27.02.2023
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 4/2023
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-023-05538-1

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