title: Trending autoregulatory indices during treatment for traumatic brain injury.
abstract: Our goal is to use automatic data monitoring for reliable prediction of episodes of intracranial hypertension in patients with traumatic brain injury. Here we test the validity of our method on retrospective patient data. We developed the Continuous Hemodynamic Autoregulatory Monitor (CHARM), that siphons and stores signals from existing monitors in the surgical intensive care unit (SICU), efficiently compresses them, and standardizes the search for statistical relationships between any proposed index and adverse events. CHARM uses an automated event detector to reliably locate episodes of elevated intracranial pressure (ICP), while eliminating artifacts within retrospective patient data. A graphical user interface allowed data scanning, selection of criteria for events, and calculating indices. The pressure reactivity index (PRx), defined as the least square linear regression slope of intracranial pressure versus arterial BP, was calculated for a single case that spanned 259 h. CHARM collected continuous records of ABP, ICP, ECG, SpO2, and ventilation from 29 patients with TBI over an 18-month period. Analysis of a single patient showed that PRx data distribution in the single hours immediately prior to all 16 intracranial hypertensive events, significantly differed from that in the 243 h that did not precede such events (p < 0.0001). The PRx index, however, lacked sufficient resolution as a real-time predictor of IH in this patient. CHARM streamlines the search for reliable predictors of intracranial hypertension. We report statistical evidence supporting the predictive potential of the pressure reactivity index.
authors.affiliation: Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA.
authors.forename: Nam
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Krasner
authors.affiliation: Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: Kosinski
authors.affiliation: Rehabilitation Sciences, University of Hartford, West Hartford, CT, 06117, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Wininger
authors.affiliation: Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Qadri
authors.affiliation: Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kappus
authors.affiliation: Department of Neurosurgery, Rutgers Cancer Institute, Rutgers-RWJ Medical School, New Brunswick, NJ, 08901, USA.
authors.forename: Shabbar
authors.initials: S
authors.lastname: Danish
authors.affiliation: Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA. craelius@rci.rutgers.edu.
authors.forename: William
authors.initials: W
authors.lastname: Craelius
mesh_terms: D016477:Artifacts; D001331:Automation; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D002560:Cerebrovascular Circulation; D003196:Computer Graphics; D001330:Electronic Data Processing; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000175:diagnosis*; D007427:Intracranial Pressure; D016018:Least-Squares Analysis; D016014:Linear Models; D008490:Medical Informatics; D008991:Monitoring, Physiologic / Q000379:methods; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted
keywords: ABP; Autoregulation; ICP; Informatics SICU; PRx; TBI; Traumatic brain injury