The Relationship Between Pressure Reactivity and Cerebral Oximetry Indexes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Single-Center Pilot Study.
Yunseo Ku, Murad Megjhani, Tammam Alalqum, Soon Bin Kwon, Daniel Nametz, Bennett Weinerman, Angela Velazquez, Shivani Ghoshal, Sachin Agarwal, David J Roh, E Sander Connolly, Jan Claassen, Soojin Park
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引用次数: 0
Abstract
Background: Patient differences from optimal mean arterial pressure (MAPOPT) derived by a cerebral oximetry index (COx_a) are associated with outcome, but the validity of COx_a-derived MAPOPT remains in question due to the lack of agreement with pressure reactivity index (PRx)-derived MAPOPT. The study aimed to elucidate the relationship between PRx and COx_a to justify the use of COx_a and COx_a-derived MAPOPT in patients with aneurysmal subarachnoid hemorrhage (aSAH).
Methods: This was a retrospective single-center study of six patients with aSAH with simultaneous near-infrared spectroscopy, intracranial pressure, and MAP monitoring. Repeated-measures Pearson correlation and Bland-Altman plot analysis were performed to compare PRx and COx_a and to compare PRx-derived MAPOPT and COx_a-derived MAPOPT. Coinciding changes in PRx and COx_a were compared, and the ability of COx_a to detect PRx-based autoregulation impairment was assessed over different time windows.
Results: Repeated-measures Pearson correlation analysis showed no correlation between PRx and COx_a (r = 0.06, p < 0.01). The correlation between PRx- and COx_a-derived MAPOPT over 388 h was r = 0.50 (p < 0.01). The bias and upper and lower limits of agreement were - 1.60, + 20.24, and - 23.43 mm Hg, respectively. The shift in the overall distribution of moving correlation to higher values as the time-window length increased was more pronounced for COx_a than PRx (COx_a: 0.09-0.41, PRx: 0.00-0.15). When using a typical PRx threshold of 0.3, COx_a was found to be ineffective in identifying impaired autoregulation across all time windows (area under the receiver operating characteristic curve: 0.494-0.527).
Conclusions: The threshold applied to PRx should not be applied to COx_a. It is suggested to consider higher thresholds for COx_a than PRx in deriving the range for MAPOPT calculations for continuous cerebral autoregulation assessment in aSAH. Further research is needed to optimize the MAPOPT derived from PRx and COx_a based on specific monitoring targets.
期刊介绍：
Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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