Leveraging Function Intersectionality and Multi-Modal Cerebrovascular Reactivity Measures for the Derivation of Individualized Intracranial Pressure Thresholds in Acute Traumatic Neural Injury.

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dc.creatorStein, Kevin Y
dc.creatorFroese, Logan
dc.creatorGomez, Alwyn
dc.creatorSainbhi, Amanjyot Singh
dc.creatorVakitbilir, Nuray
dc.creatorIslam, Abrar
dc.creatorBergmann, Tobias
dc.creatorZeiler, Frederick A
dc.date2025-06-10T11:01:06Z
dc.date2025-05-02
dc.date2025-03-18
dc.date2025-06-10T11:01:05Z
dc.date.accessioned2026-08-03T01:35:46Z
dc.descriptionPeer reviewed: True
dc.descriptionPublication status: Published
dc.descriptionFunder: Endowed Manitoba Public Insurance (MPI) Chair in Neuroscience
dc.descriptionIt has been proposed that subject-specific intracranial pressure (ICP) thresholds can be feasibly derived using the relationship between cerebrovascular reactivity and ICP. Such individualized intracranial pressure (iICP) thresholds have been suggested to have more robust associations with long-term outcomes of post-traumatic brain injury (TBI) than current guideline-based thresholds. However, both existing works have derived iICP using solely the pressure reactivity index (PRx) and a threshold of +0.20. Therefore, the goal of this study was to validate prior works and compare various cerebrovascular reactivity indices for their utility in deriving iICP. A custom iICP derivation algorithm was developed. Then, using existing archived human datasets from the Winnipeg Acute TBI Database, iICP thresholds were derived using three cerebrovascular reactivity indices: PRx, the pulse amplitude index (PAx), and the RAC (correlation (R) between the pulse amplitude of ICP (A) and cerebral perfusion pressure (C)). The yield of iICP derivation was found to vary significantly, depending on the cerebrovascular reactivity index and threshold used. A logistic regression analysis was then used to evaluate and compare the abilities of each index-derived iICP to predict the 6-month outcome. Among all index-threshold combinations tested, only PRx > 0 was able to produce an iICP that was able to outperform guideline-based ICP thresholds. PRx-based iICP seems to be superior to both PAx- and RAC-based iICP for predicting long-term outcomes. However, further work is needed to identify the ideal cerebrovascular reactivity thresholds for iICP derivation.
dc.formattext/xml
dc.formatapplication/pdf
dc.identifier2306-5354
dc.identifierbioengineering-12-00485
dc.identifierhttps://www.repository.cam.ac.uk/handle/1810/385334
dc.identifier2306-5354
dc.identifier.urihttps://repo.dare.co.zw/handle/123456789/156391
dc.languageen
dc.languageeng
dc.publisherMDPI
dc.publisherhttps://doi.org/10.3390/bioengineering12050485
dc.subjectindividualized intracranial pressure thresholds
dc.subjectintracranial pressure
dc.subjectpersonalized physiologic targets
dc.subjecttraumatic brain injury
dc.titleLeveraging Function Intersectionality and Multi-Modal Cerebrovascular Reactivity Measures for the Derivation of Individualized Intracranial Pressure Thresholds in Acute Traumatic Neural Injury.
dc.typeArticle

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