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Minerva Anestesiologica 2018 January;84(1):40-8

DOI: 10.23736/S0375-9393.17.11982-6


lingua: Inglese

Survey in expert clinicians on the validity of automated calculation of optimal cerebral perfusion pressure

Romy STEIJN 1, Roy STEWART 2, Marek CZOSNYKA 3, Joseph DONNELLY 3, Ari ERCOLE 4, Antony ABSALOM 5, Jan W. ELTING 6, Christina HAUBRICH 3, Peter SMIELEWSKI 3, Marcel ARIES 3, 7

1 Department of Intensive Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 2 Department of Medical Statistics, University of Groningen, Medical Center Groningen, Groningen, The Netherlands; 3 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK; 4 Division of Anesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK; 5 Division of Anesthesia, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 6 Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 7 Department of Intensive Care, University of Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands

BACKGROUND: Optimal cerebral perfusion pressure (CPPopt) targeting in traumatic brain injury (TBI) patients constitutes an active and controversial area of research. It has been suggested that an autoregulation guided CPP therapy may improve TBI outcome. Prerequisites of a CPPopt intervention study would be objective criteria for the CPPopt detection. This study compared the agreement between automated and visual CPPopt detection.
METHODS: Twenty-five clinicians from 18 centers worldwide, familiar with brain monitoring and using dedicated software, reviewed ten 4-hour CPPopt screenshots at 48 hours after ictus in selected TBI patients. Each screenshot displayed the trends of cerebral perfusion pressure (CPP), intracranial pressure (ICP), cerebrovascular pressure reactivity (PRx) as well as the “CPP-optimal” curve and its associated value (automated CPPopt). The main objective was to evaluate the agreement between expert clinicians as well as the agreement between the clinicians and automated CPPopt.
RESULTS: Twenty-two clinicians responded to our call (88%). Three screenshots were judged as “CPPopt not determinable” by >45% of the clinicians. For the whole group, the consensus between automated CPPopt and clinicians’ visual CPPopt was high. Three clinicians were identified as outliers. All clinicians recommended to modify CPP when patients differed >±5 mmHg from their CPPopt. The inter-observer consensus was highest in cases with current CPP below the optimal value.
CONCLUSIONS: The overall agreement between automated CPPopt and visual CPPopt identified by autoregulation experts was high, except for those cases when the curve was deemed by the clinicians not reliable enough to yield a trustworthy CPPopt.

KEY WORDS: Intracranial pressure - Cerebrovascular circulation - Neurophysiological monitoring

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