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Continuous Autoregulatory Indices Derived from Multi-modal Monitoring: Each One is Not Like the Other.

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Zeiler, FA 
Smieleweski, P 
Zweifel, C 


We assess the relationships between various continuous measures of autoregulatory capacity in an adult TBI cohort. We assessed relationships between autoregulatory indices derived from intracranial pressure (ICP: PRx, PAx, RAC), Transcranial Doppler (TCD: Mx, Sx, Dx), brain tissue-oxygenation (ORx), and spatially resolved near infrared spectroscopy (NIRS resolved: TOx, THx). Relationships between indices were assessed using Pearson correlation coefficient, Friedman (KW) test, Principle component analysis (PCA), Agglomerative Hierarchal Clustering (AHC) and K-Means Cluster Analysis (KMCA). All analytic techniques were repeated for a range of temporal resolutions of data, including minute-by-minute averages, moving means of 30 samples, and grand mean for each patient. Thirty-seven patients were studied. PRx displayed strong association with PAx/RAC across all the analytical techniques: Pearson correlation (r=0.682/ r=0.677, p<0.0001), PCA, AHC and KMCA in the grand mean data sheet. Most TCD based indices (Mx, Dx) were correlated and co-clustered on PCA, AHC and KMCA. Sx was found to be more closely associated with ICP derived indices on Pearson correlation, PCA, AHC and KMCA. NIRS indices displayed variable correlation with each other and with indices derived from ICP and TCD signals. Of interest, TOx and THx co-cluster with ICP based indices on PCA and AHC. ORx failed to display any meaningful correlations with other indices in neither of the analytical method used. Thirty minute moving average and minute-by-minute data set displayed similar results across all the methods. RAC, Mx and Sx were the strongest predictors of outcome at 6 months. Continuously updating autoregulatory indices are not all correlated with one another. Caution must be advised when utilizing less commonly described autoregulation indices (ie. ORx) for the clinical assessment of autoregulatory capacity, as they appear to not be related to commonly measured/establish indices, such as PRx. Further prospective validation is required.



CBF autoregulation, HEAD TRAUMA, ROUTINE PHYSIOLOGICAL MONITORING, autoregulation, autoregulation index, multimodal monitoring co-variance.

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Journal of Neurotrauma

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Mary Ann Liebert
Medical Research Council (G0600986)
Medical Research Council (G0600986/1)