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dc.contributor.authorVarsos, Georgios Ven
dc.contributor.authorKolias, Angelosen
dc.contributor.authorSmielewski, Peteren
dc.contributor.authorBrady, Ken Men
dc.contributor.authorVarsos, Vassilis Gen
dc.contributor.authorHutchinson, Peteren
dc.contributor.authorPickard, Johnen
dc.contributor.authorCzosnyka, Mareken
dc.date.accessioned2015-03-25T10:04:01Z
dc.date.available2015-03-25T10:04:01Z
dc.date.issued2015-01-09en
dc.identifier.citationJournal of Neurosurgery 2015, 123(3), 638-648. doi: 10.3171/2014.10.JNS14613.en
dc.identifier.issn0022-3085
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/247174
dc.description.abstractOBJECT Cerebral blood flow is associated with cerebral perfusion pressure (CPP), which is clinically monitored through arterial blood pressure (ABP) and invasive measurements of intracranial pressure (ICP). Based on critical closing pressure (CrCP), the authors introduce a novel method for a noninvasive estimator of CPP (eCPP). METHODS Data from 280 head-injured patients with ABP, ICP, and transcranial Doppler ultrasonography measurements were retrospectively examined. CrCP was calculated with a noninvasive version of the cerebrovascular impedance method. The eCPP was refined with a predictive regression model of CrCP-based estimation of ICP from known ICP using data from 232 patients, and validated with data from the remaining 48 patients. RESULTS Cohort analysis showed eCPP to be correlated with measured CPP (R = 0.851, p < 0.001), with a mean ± SD difference of 4.02 ± 6.01 mm Hg, and 83.3% of the cases with an estimation error below 10 mm Hg. eCPP accurately predicted low CPP (< 70 mm Hg) with an area under the curve of 0.913 (95% CI 0.883–0.944). When each recording session of a patient was assessed individually, eCPP could predict CPP with a 95% CI of the SD for estimating CPP between multiple recording sessions of 1.89–5.01 mm Hg. CONCLUSIONS Overall, CrCP-based eCPP was strongly correlated with invasive CPP, with sensitivity and specificity for detection of low CPP that show promise for clinical use.
dc.description.sponsorshipG. Varsos is supported by an A. G. Leventis Foundation Scholarship and a Charter Studentship from St. Edmund’s College, Cambridge. Dr. Kolias is supported by a Royal College of Surgeons of England Research Fellowship, a National Institute for Health Research (NIHR) Academic Clinical Fellowship, and a Raymond and Beverly Sackler Studentship. He also chairs the British Neurosurgical Trainee Research Collaborative, which has been supported with an educational grant from Codman. Dr. Hutchinson is supported by an NIHR Research Professorship, the NIHR Cambridge Biomedical Research Centre, and has been appointed as the Surgical Specialty Lead for Neurosurgery, Royal College of Surgeons of England Clinical Research Initiative. He is a director of Technicam, a manufacturer of cranial access devices for neuromonitoring. He has also received honoraria from Codman. J. Pickard’s research (excluding salary) is supported by the NIHR Cambridge Biomedical Research Centre and an NIHR Senior Investigator Award. ICM+ Software is licensed by Cambridge Enterprise, Cambridge, UK, and Dr. Czosnyka and Dr. Smielewski have a financial interest in a fraction of the licensing fee. Dr. Czosnyka has also served as a consultant to Codman.
dc.languageEnglishen
dc.language.isoenen
dc.publisherAmerican Association of Neurological Surgeons
dc.subjectcerebral perfusion pressureen
dc.subjectcritical closing pressureen
dc.subjectnoninvasive modelen
dc.subjecttranscranial Doppler ultrasonographyen
dc.subjectvascular disordersen
dc.titleA noninvasive estimation of cerebral perfusion pressure using critical closing pressureen
dc.typeArticle
dc.description.versionThis is the author accepted manuscript. The final version is available from American Association of Neurological Surgeons via http://dx.doi.org/10.3171/2014.10.JNS14613.en
prism.endingPage648
prism.publicationDate2015en
prism.publicationNameJournal of Neurosurgeryen
prism.startingPage638
prism.volume123en
dc.rioxxterms.funderNIHR
rioxxterms.versionofrecord10.3171/2014.10.JNS14613en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2015-01-09en
dc.contributor.orcidKolias, Angelos [0000-0003-3992-0587]
dc.contributor.orcidSmielewski, Peter [0000-0001-5096-3938]
dc.contributor.orcidHutchinson, Peter [0000-0002-2796-1835]
dc.contributor.orcidPickard, John [0000-0002-5762-6667]
dc.contributor.orcidCzosnyka, Marek [0000-0003-2446-8006]
dc.identifier.eissn1933-0693
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idTCC (NIHR-RP-R3-12-013)
pubs.funder-project-idMRC (G0601025)
pubs.funder-project-idMRC (G0600986)
pubs.funder-project-idMRC (G9439390)
pubs.funder-project-idMRC (G0001237)
rioxxterms.freetoread.startdate2016-01-09


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