• J Clin Monit Comput · Dec 2024

    An open source autoregulation-based neuromonitoring algorithm shows PRx and optimal CPP association with pediatric traumatic brain injury.

    • Eris van Twist, Tahisa B Robles, Bart Formsma, Naomi Ketharanathan, Maayke Hunfeld, C M Buysse, Matthijs de Hoog, Alfred C Schouten, de JongeRogier C JRCJDepartment of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands., and Jan W Kuiper.
    • Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands. e.vantwist@erasmusmc.nl.
    • J Clin Monit Comput. 2024 Dec 19.

    AbstractThis study aimed to develop an open-source algorithm for the pressure-reactivity index (PRx) to monitor cerebral autoregulation (CA) in pediatric severe traumatic brain injury (sTBI) and compared derived optimal cerebral perfusion pressure (CPPopt) with real-time CPP in relation to long-term outcome. Retrospective study in children (< 18 years) with sTBI admitted to the pediatric intensive care unit (PICU) for intracranial pressure (ICP) monitoring between 2016 and 2023. ICP was analyzed on an insult basis and correlated with outcome. PRx was calculated as Pearson correlation coefficient between ICP and mean arterial pressure. CPPopt was derived as weighted average of CPP-PRx over time. Outcome was determined via Pediatric Cerebral Performance Category (PCPC) scale at one year post-injury. Logistic regression and mixed effect models were developed to associate PRx and CPPopt with outcome. In total 50 children were included, 35 with favorable (PCPC 1-3) and 15 with unfavorable outcome (PCPC 4-6). ICP insults correlated with unfavorable outcome at 20 mmHg for 7 min duration. Mean CPPopt yield was 75.4% of monitoring time. Mean and median PRx and CPPopt yield associated with unfavorable outcome, with odds ratio (OR) 2.49 (1.38-4.50), 1.38 (1.08-1.76) and 0.95 (0.92-0.97) (p < 0.001). PRx thresholds 0.0, 0.20, 0.25 and 0.30 resulted in OR 1.01 (1.00-1.02) (p < 0.006). CPP in optimal range associated with unfavorable outcome on day one (0.018, p = 0.029) and four (-0.026, p = 0.025). Our algorithm can obtain optimal targets for pediatric neuromonitoring that showed association with long-term outcome, and is now available open source.© 2024. The Author(s).

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