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Validation of Pressure Reactivity and Pulse Amplitude Indices against the Lower Limit of Autoregulation, Part I: Experimental Intracranial Hypertension.

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cam.issuedOnline2018-10-04
dc.contributor.authorZeiler, Frederick A
dc.contributor.authorDonnelly, Joseph
dc.contributor.authorCalviello, Leanne
dc.contributor.authorLee, Jennifer K
dc.contributor.authorSmielewski, Peter
dc.contributor.authorBrady, Ken
dc.contributor.authorKim, Dong-Joo
dc.contributor.authorCzosnyka, Marek
dc.contributor.orcidZeiler, Frederick [0000-0003-1737-0510]
dc.contributor.orcidDonnelly, Joseph [0000-0002-6502-8069]
dc.contributor.orcidCalviello, Leanne [0000-0001-5012-2725]
dc.contributor.orcidSmielewski, Peter [0000-0001-5096-3938]
dc.contributor.orcidCzosnyka, Marek [0000-0003-2446-8006]
dc.date.accessioned2018-10-18T10:21:29Z
dc.date.available2018-10-18T10:21:29Z
dc.date.issued2018-12-01
dc.description.abstractThe purpose of this study was to provide validation of intracranial pressure (ICP) derived continuous indices of cerebrovascular reactivity against the lower limit of autoregulation (LLA). Utilizing an intracranial hypertension model within white New Zealand rabbits, ICP, transcranial Doppler (TCD), laser Doppler flowmetry (LDF), and arterial blood pressure were recorded. Data were retrospectively analyzed in a cohort of 12 rabbits with adequate signals for interrogating the LLA. We derived continuous indices of cerebrovascular reactivity: PRx (correlation between ICP and mean arterial pressure [MAP]), PAx (correlation between pulse amplitude of ICP [AMP] and MAP), and Lx (correlation between LDF-based cerebral blood flow [CBF] and cerebral perfusion pressure [CPP]). LLA was derived via piecewise linear regression of CPP versus LDF or CPP versus systolic flow velocity (FVs) plots. We then produced error bar plots for PRx, PAx, and Lx against 2.5 mm Hg bins of CPP, to display the relationship between these indices and the LLA. We compared the CPP values at clinically relevant thresholds of PRx and PAx, to the CPP defined at the LLA. Receiver operating curve (ROC) analysis was performed for each index across the LLA using 2.5 mm Hg bins for CPP. The mean LLA was 51.5 ± 8.2 mm Hg. PRx and PAx error bar plots demonstrate that each index correlates with the LLA, becoming progressively more positive below the LLA. Similarly, CPP values at clinically relevant thresholds of PRx and PAx were not statistically different from the CPP derived at the LLA. Finally, ROC analysis indicated that PRx and PAx predicted the LAA, with areas under the curve (AUCs) of 0.795 (95% confidence interval [CI]: 0.731-0.857, p < 0.0001) and 0.703 (95% CI: 0.631-0.775, p < 0.0001), respectively. Both PRx and PAx generally agree with LLA within this experimental model of intracranial hypertension. Further analysis of clinically used indices of autoregulation across the LLA within pure arterial hypotension models is required.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.31498
dc.identifier.eissn1557-9042
dc.identifier.issn0897-7151
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/284127
dc.languageeng
dc.language.isoeng
dc.publisherMary Ann Liebert Inc
dc.publisher.urlhttp://dx.doi.org/10.1089/neu.2017.5603
dc.subjectLLA
dc.subjectautoregulation
dc.subjectcontinuous indices
dc.subjectexperimental
dc.subjectvalidation
dc.subjectAnimals
dc.subjectArterial Pressure
dc.subjectCerebrovascular Circulation
dc.subjectFemale
dc.subjectHomeostasis
dc.subjectIntracranial Hypertension
dc.subjectIntracranial Pressure
dc.subjectMale
dc.subjectRabbits
dc.titleValidation of Pressure Reactivity and Pulse Amplitude Indices against the Lower Limit of Autoregulation, Part I: Experimental Intracranial Hypertension.
dc.typeArticle
dcterms.dateAccepted2018-06-27
prism.endingPage2811
prism.issueIdentifier23
prism.publicationDate2018
prism.publicationNameJ Neurotrauma
prism.startingPage2803
prism.volume35
rioxxterms.licenseref.startdate2018-12
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1089/neu.2017.5603

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