Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study

被引：27

作者：

Zeiler, Frederick A. ^{[1
,2
,3
]}

Ercole, Ari ^{[1
]}

Cabeleira, Manuel ^{[3
]}

Beqiri, Erta ^{[3
,4
]}

Zoerle, Tommaso ^{[5
]}

Carbonara, Marco ^{[5
]}

Stocchetti, Nino ^{[4
,5
]}

Menon, David K. ^{[1
]}

Smielewski, Peter ^{[3
]}

Czosnyka, Marek ^{[3
,6
]}

Anke, Audny ^{[7
]}

Beer, Ronny ^{[8
]}

Bellander, Bo-Michael ^{[9
]}

Buki, Andras ^{[10
,11
,12
]}

Chevallard, Giorgio ^{[13
]}

Chieregato, Arturo ^{[13
]}

Citerio, Giuseppe ^{[14
,15
]}

Czeiter, Endre ^{[10
,11
,12
]}

Depreitere, Bart ^{[16
]}

Eapen, George

Frisvold, Shirin ^{[17
]}

Helbok, Raimund ^{[8
]}

Jankowski, Stefan ^{[18
]}

Kondziella, Daniel ^{[19
,20
,21
]}

Koskinen, Lars-Owe ^{[22
]}

Meyfroidt, Geert ^{[23
]}

Moeller, Kirsten ^{[21
]}

Nelson, David ^{[9
]}

Piippo-Karjalainen, Anna ^{[24
]}

Radoi, Andreea ^{[25
]}

Ragauskas, Arminas ^{[26
,27
]}

Raj, Rahul ^{[24
]}

Rhodes, Jonathan ^{[28
,29
]}

Rocka, Saulius ^{[26
,27
]}

Rossaint, Rolf ^{[30
]}

Sahuquillo, Juan ^{[25
]}

Sakowitz, Oliver ^{[31
,32
]}

Stevanovic, Ana ^{[30
]}

Sundstrom, Nina ^{[33
]}

Takala, Riikka ^{[34
,35
]}

Tamosuitis, Tomas ^{[36
]}

Tenovuo, Olli ^{[35
,37
]}

Vajkoczy, Peter ^{[38
]}

Vargiolu, Alessia ^{[14
]}

Vilcinis, Rimantas ^{[39
]}

Wolf, Stefan ^{[40
]}

Younsi, Alexander ^{[32
]}

机构：

[1] Univ Cambridge, Addenbrookes Hosp, Div Anaesthesia, Cambridge, England

[2] Univ Manitoba, Rady Fac Hlth Sci, Dept Surg, Winnipeg, MB R3A 1R9, Canada

[3] Univ Cambridge, Addenbrookes Hosp, Div Neurosurg, Brain Phys Lab, Cambridge, England

[4] Milan Univ, Dept Physiopathol & Transplantat, Milan, Italy

[5] Neuro ICU Fdn IRCCS Ca Granda Osped Maggiore Poli, Milan, Italy

[6] Warsaw Univ Technol, Inst Elect Syst, Warsaw, Poland

[7] Univ Hosp Northern Norway, Dept Phys Med & Rehabil, Tromso, Norway

[8] Med Univ Innsbruck, Dept Neurol, Neurol Intens Care Unit, Innsbruck, Austria

[9] Karolinska Univ Hosp, Dept Neurosurg & Anesthesia & Intens Care Med, Stockholm, Sweden

[10] Univ Pecs, Dept Neurosurg, Pecs, Hungary

[11] Univ Pecs, MTA PTE Clin Neurosci MR Res Grp, Hungarian Brain Res Program, Pecs, Hungary

[12] Univ Pecs, Janos Szentagothai Res Ctr, Hungarian Brain Res Program, Pecs, Hungary

[13] Osped Niguarda Ca Granda, NeuroIntens Care, Milan, Italy

[14] ASST Monza, Dept Anesthesia & Intens Care, NeuroIntens Care Unit, Monza, Italy

[15] Univ Milano Bicocca, Sch Med & Surg, Milan, Italy

[16] Univ Hosp Leuven, Dept Neurosurg, Leuven, Belgium

[17] Univ Hosp Northern Norway, Dept Anesthesiol & Intens Care, Tromso, Norway

[18] Sheffield Teaching Hosp NHS Fdn Trust, Neurointens Care, Sheffield, S Yorkshire, England

[19] Reg Hovedstaden Rigshosp, Dept Neurol, Copenhagen, Denmark

[20] Reg Hovedstaden Rigshosp, Dept Clin Neurophysiol, Copenhagen, Denmark

[21] Reg Hovedstaden Rigshosp, Dept Neuroanesthesiol, Copenhagen, Denmark

[22] Umea Univ Hosp, Dept Clin Neurosci, Neurosurg, Umea, Sweden

[23] Univ Hosp Leuven, Intens Care Med, Leuven, Belgium

[24] Univ Helsinki, Cent Hosp, Helsinki, Finland

[25] Vall dHebron Univ Hosp, Dept Neurosurg, Barcelona, Spain

[26] Kaunas Univ Technol, Dept Neurosurg, Vilnius, Lithuania

[27] Vilnius Univ, Vilnius, Lithuania

[28] NHS Lothian, Dept Anaesthesia Crit Care & Pain Med, Edinburgh, Midlothian, Scotland

[29] Univ Edinburgh, Edinburgh, Midlothian, Scotland

[30] Univ Hosp Aachen, Dept Anaesthesiol, Aachen, Germany

[31] Klinikum Ludwigsburg, Klin Neurochirurg, Ludwigsburg, Germany

[32] Univ Hosp Heidelberg, Dept Neurosurg, Heidelberg, Germany

[33] Umea Univ Hosp, Dept Radiat Sci, Biomed Engn, Umea, Sweden

[34] Turku Univ, Cent Hosp, Perioperat Serv Intens Care Med & Pain Management, Turku, Finland

[35] Univ Turku, Turku, Finland

[36] Kaunas Univ Hlth Sci, Neurointens Care Unit, Kaunas, Lithuania

[37] Turku Univ, Cent Hosp, Rehabil & Brain Trauma, Turku, Finland

[38] Charite Univ Med Berlin, Neurol Neurochirurg & Psychiat, Berlin, Germany

[39] Kaunas Univ Hlth Sci, Dept Neurosurg, Kaunas, Lithuania

[40] Charite Univ Med Berlin, Interdisciplinary Neuro Intens Care Unit, Berlin, Germany

来源：

ACTA NEUROCHIRURGICA | 2019年 / 161卷 / 07期

关键词：

Compensatory reserve; Intracranial pressure; Outcome; Weighted ICP; MANAGEMENT;

D O I：

10.1007/s00701-019-03915-3

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BackgroundCompensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort.MethodsUsing the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived ICP and wICP (calculated as wICP=(1-RAP)xICP; where RAP is the compensatory reserve index derived from the moving correlation between pulse amplitude of ICP and ICP). Various univariate logistic regression models were created comparing ICP and wICP to dichotomized outcome at 6 to 12months, based on Glasgow Outcome ScoreExtended (GOSE) (alive/deadGOSE 2/GOSE=1; favorable/unfavorableGOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values.ResultswICP displayed higher AUC compared to ICP on univariate regression for alive/dead outcome compared to mean ICP (AUC 0.712, 95% CI 0.615-0.810, p=0.0002, and AUC 0.642, 95% CI 0.538-746, p<0.0001, respectively; no significant difference on Delong's test), and for favorable/unfavorable outcome (AUC 0.627, 95% CI 0.548-0.705, p=0.015, and AUC 0.495, 95% CI 0.413-0.577, p=0.059; significantly different using Delong's test p=0.002), with lower wICP values associated with improved outcomes (p<0.05 for both). These relationships on univariate analysis held true even when comparing the wICP models with those containing both ICP and RAP integrated area under the curve over time (p<0.05 for all via Delong's test).ConclusionsCompensatory-reserve-weighted ICP displays superior outcome association for both alive/dead and favorable/unfavorable dichotomized outcomes in adult TBI, through univariate analysis. Lower wICP is associated with better global outcomes. The results of this study provide multi-center validation of those seen in a previous single-center study.

引用

页码：1275 / 1284

页数：10

共 12 条

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