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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The study aimed to elucidate the relationship between PRx and COx_a to justify the use of COx_a and COx_a-derived MAP<sub>OPT</sub> in patients with aneurysmal subarachnoid hemorrhage (aSAH).</p><p><strong>Methods: </strong>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 MAP<sub>OPT</sub> and COx_a-derived MAP<sub>OPT</sub>. 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.</p><p><strong>Results: </strong>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 MAP<sub>OPT</sub> 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).</p><p><strong>Conclusions: </strong>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 MAP<sub>OPT</sub> calculations for continuous cerebral autoregulation assessment in aSAH. 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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).</p><p><strong>Conclusions: </strong>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 MAP<sub>OPT</sub> calculations for continuous cerebral autoregulation assessment in aSAH. 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引用次数: 0
摘要
背景：患者与由脑氧饱和度指数（COx_a）得出的最佳平均动脉压（MAPOPT）的差异与结果相关，但由于与压力反应性指数（PRx）得出的MAPOPT缺乏一致性，COx_a得出的MAPOPT的有效性仍然存在问题。本研究旨在阐明PRx和COx_a之间的关系，以证明在动脉瘤性蛛网膜下腔出血（aSAH）患者中使用COx_a和COx_a衍生的MAPOPT是合理的。方法：对6例aSAH患者进行回顾性单中心研究，同时进行近红外光谱、颅内压和MAP监测。采用重复测量Pearson相关和Bland-Altman图分析比较PRx和COx_a，比较PRx衍生的MAPOPT和COx_a衍生的MAPOPT。比较了PRx和COx_a的一致变化，并在不同的时间窗内评估了COx_a检测基于PRx的自动调节损伤的能力。结果：重复测量Pearson相关分析显示PRx与COx_a无相关性（r = 0.06）， p OPT超过388 hr = 0.50 (p)。结论：适用于PRx的阈值不适用于COx_a。建议考虑COx_a的阈值高于PRx，以推导MAPOPT计算范围，用于aSAH的连续大脑自动调节评估。基于特定的监测目标，需要进一步研究优化PRx和COx_a衍生的MAPOPT。
The Relationship Between Pressure Reactivity and Cerebral Oximetry Indexes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Single-Center Pilot Study.
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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