Cerebral physiologic insult burden in acute traumatic neural injury: a Canadian High Resolution-TBI (CAHR-TBI) descriptive analysis

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dc.contributor.authorStein, Kevin Y.
dc.contributor.authorGomez, Alwyn
dc.contributor.authorGriesdale, Donald
dc.contributor.authorSekhon, Mypinder
dc.contributor.authorBernard, Francis
dc.contributor.authorGallagher, Clare
dc.contributor.authorThelin, Eric P.
dc.contributor.authorRaj, Rahul
dc.contributor.authorAries, Marcel
dc.contributor.authorFroese, Logan
dc.contributor.authorKramer, Andreas
dc.contributor.authorZeiler, Frederick A.
dc.date.accessioned2024-10-01T17:41:33Z
dc.date.available2024-10-01T17:41:33Z
dc.date.issued2024-09-04
dc.date.updated2024-10-01T03:45:19Z
dc.description.abstractBackground Over the recent decades, continuous multi-modal monitoring of cerebral physiology has gained increasing interest for its potential to help minimize secondary brain injury following moderate-to-severe acute traumatic neural injury (also termed traumatic brain injury; TBI). Despite this heightened interest, there has yet to be a comprehensive evaluation of the effects of derangements in multimodal cerebral physiology on global cerebral physiologic insult burden. In this study, we offer a multi-center descriptive analysis of the associations between deranged cerebral physiology and cerebral physiologic insult burden. Methods Using data from the Canadian High-Resolution TBI (CAHR-TBI) Research Collaborative, a total of 369 complete patient datasets were acquired for the purposes of this study. For various cerebral physiologic metrics, patients were trichotomized into low, intermediate, and high cohorts based on mean values. Jonckheere–Terpstra testing was then used to assess for directional relationships between these cerebral physiologic metrics and various measures of cerebral physiologic insult burden. Contour plots were then created to illustrate the impact of preserved vs impaired cerebrovascular reactivity on these relationships. Results It was found that elevated intracranial pressure (ICP) was associated with more time spent with cerebral perfusion pressure (CPP) < 60 mmHg and more time with impaired cerebrovascular reactivity. Low CPP was associated with more time spent with ICP > 20 or 22 mmHg and more time spent with impaired cerebrovascular reactivity. Elevated cerebrovascular reactivity indices were associated with more time spent with CPP < 60 mmHg as well as ICP > 20 or 22 mmHg. Low brain tissue oxygenation (PbtO2) only demonstrated a significant association with more time spent with CPP < 60 mmHg. Low regional oxygen saturation (rSO2) failed to produce a statistically significant association with any particular measure of cerebral physiologic insult burden. Conclusions Mean ICP, CPP and, cerebrovascular reactivity values demonstrate statistically significant associations with global cerebral physiologic insult burden; however, it is uncertain whether measures of oxygen delivery provide any significant insight into such insult burden.
dc.identifier.citationCritical Care. 2024 Sep 04;28(1):294
dc.identifier.doi10.1186/s13054-024-05083-y
dc.identifier.urihttp://hdl.handle.net/1993/38640
dc.language.isoeng
dc.language.rfc3066en
dc.publisherBMC
dc.rights.holderThe Author(s)
dc.subjectTraumatic brain injury
dc.subjectCerebral physiologic insult burden
dc.subjectMulti-modal monitoring
dc.subjectCerebral physiology
dc.titleCerebral physiologic insult burden in acute traumatic neural injury: a Canadian High Resolution-TBI (CAHR-TBI) descriptive analysis
dc.typeJournal Article
local.author.affiliationPrice Faculty of Engineering::Department of Biosystems Engineering
oaire.citation.issue294
oaire.citation.titleCritical Care
oaire.citation.volume28
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