Innovative Method for Real-time Assessment of Intracranial Compliance

实时评估颅内顺应性的创新方法

• 批准号: 9901747
• 负责人: Robert S B Clark
• 金额: $ 43.04万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-15 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9901747
• 关键词: Address; Adult; Algorithms; Bedside Technology; Blood; Blood Pressure; Blood Vessels; Brain; Carbon Dioxide; Cardiovascular system; Cause of Death; Cerebrovascular Circulation; Cerebrum; Child; Childhood Injury; Clinical; Computers; Coupled; Data; Decision Making; Development; Devices; Electronic Health Record; Guidelines; Head; Human; Impairment; Injury; Institutional Review Boards; Intervention; Intracranial Hypertension; Intracranial Pressure; Knowledge; Laws; Length of Stay; Life; Lung; Machine Learning; Measurement; Measures; Mechanical ventilation; Medical; Medicine; Methods; Modeling; Monitor; Morbidity - disease rate; Neurologic; Neurological outcome; Operative Surgical Procedures; Osmolar Concentration; Partial Pressure; Patient Care; Patient Monitoring; Patients; Pattern; Perfusion; Pharmaceutical Preparations; Physiological; Physiology; Radial; Running; Savings; Sedation procedure; Sentinel; Series; Signal Transduction; Surgical Decompression; TBI Patients; Testing; Therapeutic Intervention; Time; Titrations; Traumatic Brain Injury; Validation; Weaning; base; care outcomes; cerebral blood volume; cerebrovascular; clinical application; clinically relevant; cohort; comparative; data streams; density; improved; indexing; innovation; insight; large datasets; models and simulation; patient response; point of care; prevent; regional difference; response; signal processing; standard of care; therapeutic target; tool

"Standard of care" neurological monitoring for patients with severe traumatic brain injury (TBI) - a leading cause of death and long-term neurological impairment in children and adults-has not changed in decades, relying mainly on intracranial pressure {ICP) monitoring. Remarkably, the use of ICP alone as a therapeutic target for severe TBI is currently controversial due to a lack of robust supporting evidence, especially for its use in children. To address this clinical need, we developed the ICP-PC02 Compliance Index (ICP-PCI), an algorithm to compute dynamic intracranial compliance in real-time by integrating continuous ICP and end tidal CO, (ETC02) data streams. Bedside assessment of intracranial compliance-the relationship between changes in ICP and concomitant changes in intracranial volume, has been limited because of the lack of point-of-care devices to measure cerebral blood flow (CBF)/cerebral blood volume (CBV). The ICP-PCI is based on the well-known and robust relationship between the partial pressure of CO2 in blood (PC02) and CBV, where a change in PC02 of 1 mmHg induces an -3% change in CBF in patients with severe TBI. Since CBF is proportional to blood vessel radius to the fourth power, changes in CBF reflect immediate changes in CBV. As continuous ICP and ETC02 monitoring are standard of care for patients with severe TBI, ICP-PCI can be determined using existing ICU monitoring. To date we have obtained preliminary data in children with severe TBI in an IRB approved study that validates the physiologic premise and demonstrates feasibility for measurement of ICPPCI using existing, continuous ICU monitoring deemed guidelines-based standard of care. In this proposal, dense time series data, including continuous ETC02, ICP, and other physiologic waveforms will be interrogated. ICP-PCI will be calculated as the running moment-to-moment correlation between ETC02 and ICP across optimized temporal epochs, and subject to additional signal processing. We will confirm our findings across a larger cohort and define the temporal pattern of ICP-PCI and associations with relevant clinical variables: ICP, CPP, duration of ICP monitoring, medical and surgical interventions, and ICU and hospital length of stay. In addition, high-density, time series data will be integrated and time-synchronized with electronic health record (EHR) data and simulation models will be generated and refined to define the capacity for ICP-PCI to predict the need and response to relevant medical and surgical interventions. Clinical application of ICP-PCI will be compared head-to-head with ICP alone. Successful validation of ICP-PCI would lay the groundwork for the development of a valuable clinical tool for all Centers managing children and possibly adults with severe TBI, that could be readily integrated and implemented using existing ICU monitoring.

严重创伤性脑损伤（TBI）患者的“护理标准”监测 - 领先 几十年来儿童和成人的死亡和长期神经损害不变， 主要依靠颅内压（ICP）监测。值得注意的是，单独使用ICP作为治疗 由于缺乏强大的辅助证据，目前引起了严重TBI的目标，尤其是为了使用 在儿童中。 为了满足这种临床需求，我们开发了ICP-PC02合规指数（ICP-PCI），算法 通过整合连续的ICP和End Tidal CO实时计算动态颅内依从性， （ETC02）数据流。颅内合规性评估 - 变化之间的关系 ICP和颅内体积的伴随变化受到限制，因为缺乏护理 测量脑血流量（CBF）/脑血体积（CBV）的装置。 ICP-PCI是基于知名的 二氧化碳在血液（PC02）和CBV中的局部压力之间的牢固关系，其中发生了变化 在1 mmHg的PC02中，严重TBI患者的CBF诱导-3％变化。由于CBF与 血管半径为第四功率，CBF的变化反映了CBV的立即变化。作为连续的ICP ETC02监测是严重TBI患者的护理标准，可以使用ICP-PCI确定 现有的ICU监视。迄今为止，我们已经在IRB中获得了严重TBI儿童的初步数据 批准的研究验证生理前提并证明了ICPPCI测量的可行性 使用现有的，连续的ICU监视，认为基于指南的护理标准。在此提案中， 密集的时间序列数据，包括连续ETC02，ICP和其他生理波形 询问。 ICP-PCI将被计算为ETC和eack之间的运行矩与时刻的相关性 ICP跨越了优化的时间时期，并受到其他信号处理。我们将确认我们的 跨较大队列的发现，并定义ICP-PCI的时间模式以及与相关的关联 临床变量：ICP，CPP，ICP监测的持续时间，医学和外科干预措施以及ICU和ICU和 住院时间。此外，高密度，时间序列数据将集成并与时间同步 电子健康记录（EHR）数据和仿真模型将产生并精制以定义容量 ICP-PCI可以预测相关的医学和外科干预措施的需求和响应。临床 ICP-PCI的应用将与仅ICP进行比较。成功验证ICP-PCI 将为所有管理中心的有价值的临床工具开发奠定基础 儿童，可能是患有严重TBI的成年人，可以很容易地使用和实施 现有的ICU监视。