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.

《护理标准》重型颅脑损伤患者的神经学监测--领先 儿童和成人的死亡原因和长期神经损害-几十年来没有改变， 主要依靠颅内压(ICP)监测。值得注意的是，仅使用ICP作为一种治疗方法 由于缺乏强有力的支持证据，尤其是对其使用缺乏有力的支持，目前针对严重脑外伤的靶点存在争议 在孩子们身上。 为了满足这一临床需求，我们开发了一种名为ICPPC02遵从性指数(ICPPCI)的算法 通过积分连续的颅内压和呼气末二氧化碳分压实时计算动态的颅内顺应性， (ETC02)数据流。对颅内顺应性的床边评估--变化之间的关系 由于缺乏护理点，颅内压及伴随的颅内体积变化有限 测量脑血流量(CBF)/脑血容量(CBV)的设备。该接口是基于著名的 血液中二氧化碳分压(PC02)和CBV之间的牢固关系，其中 在PC02中，1毫米汞柱可使重型颅脑损伤患者的脑血流量改变-3%。由于CBF与 血管半径的四次方，CBF的变化反映CBV的即时变化。作为连续的互联网内容提供商 和ETC02监测是重型颅脑损伤患者的标准护理，可以用以下方法确定ICP-PCI 现有的ICU监控。到目前为止，我们已经在IRB中获得了严重脑外伤儿童的初步数据 经批准的研究，证实了生理前提并论证了测量心内直视手术的可行性 使用现有的、持续的ICU监测被视为以指南为基础的护理标准。在这份提案中， 密集的时间序列数据，包括连续的ETC02、ICP等生理波形 被审问了。将根据ETC02和ETC02之间的运行时刻与时刻的相关性来计算ICP-PCI值 经过优化的时间周期的ICP值，并接受额外的信号处理。我们将确认我们的 在更大的队列中的发现，并定义了ICP-PCI的时间模式以及与相关因素的关联 临床变量：颅内压，CPP，颅内压监测时间，内科和外科干预，ICU和 住院时间。此外，还将整合高密度的时间序列数据，并与 将生成并改进电子健康记录(EHR)数据和模拟模型，以定义容量 用于预测相关内外科干预措施的需求和反应。临床 将与单独应用ICP-PCI进行正面比较。成功验证了ICP-PCI术 将为所有中心管理的有价值的临床工具的开发奠定基础 儿童和可能患有严重脑外伤的成人，可以很容易地整合和实施使用 现有的ICU监控。