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1. Are NIRS-derived cerebral autoregulation and ABPopt values different between hemispheres in hypoxic-ischemic brain injury patients following cardiac arrest?

Author: Hazenberg, L, Aries, MJH, Beqiri, E, Mess, WH, van Mook, WNKA, Delnoij, T, Zeiler, FA, van Kuijk, SMJ, and Tas, J
Published: 2023
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2. Advanced neuromonitoring powered by ICM+ and its place in the Brand New AI World, reflections at the 20th anniversary boundary

Author: Smielewski, P., Beqiri, E., Mataczynski, C., Placek, M., Kazimierska, A., Hutchinson, P.J., Czosnyka, M., and Kasprowicz, M.
Published: 2024
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3. Research considerations for prospective studies of patients with coma and disorders of consciousness

Author: Tinti, L, Lawson, T, Molteni, E, Kondziella, D, Rass, V, Sharshar, T, Bodien, Y, Giacino, J, Mayer, S, Amiri, M, Muehlschlegel, S, Venkatasubba Rao, C, Vespa, P, Menon, D, Citerio, G, Helbok, R, Mcnett, M, Agarwal, S, Aiyagari, V, Akbari, Y, Albertson, A, Alexander, S, Alexandrov, A, Alkhachroum, A, Al-Mufti, F, Appavu, B, Gebrewold, M, Ayounb, M, Badenes, R, Bader, M, Badjiata, N, Balu, R, Barlow, B, Barra, M, Beekman, R, Beghi, E, Beqiri, E, Berlin, T, Bilotta, F, Bleck, T, Boerwinkle, V, Boly, M, Bonnel, A, Brazzi, L, Brown, E, Bulic, S, Caceres, E, Caceres, A, Cafiero, T, Carroll, E, Cediel, E, Chou, S, Claassen, J, Condie, C, Conti, A, Cosmas, K, Costa, P, Creutzfeldt, C, Dangayach, N, Dauri, M, Debicki, D, Degeorgia, M, Der-Nigoghossian, C, Desai, M, Dhar, R, Diringer, M, Durr, E, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Farrokh, S, Ferguson, A, Fernandez-Espejo, D, Fink, E, Fins, J, Foreman, B, Franchi, F, Frontera, J, Ganesan, R, Gaspard, N, Ghavam, A, Gibbons, C, Gilmore, E, Glustein, C, Gosseries, O, Green, T, Greer, D, Guanci, M, Gupta, D, Hahn, C, Hakimi, R, Hammond, F, Hanley, D, Hartings, J, Hassan, A, Hemphill, C, Da Cunha, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Johnson, S, Jones, M, Jox, R, Kalanuria, A, Keller, E, Kennedy, L, Kennelly, M, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kreitzer, N, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Macdonald, J, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Mascia, L, Massimini, M, Mathur, R, Mccredie, V, Mejia-Mantilla, J, Mendoza, M, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Montalenti, E, Monti, M, Morrison, C, Munar, M, Murtaugh, B, Naccache, L, Nagayama, M, Nairon, E, Nakagawa, T, Naldi, A, Narenthiran, G, Natarajan, G, Nemetsky, E, Newcombe, V, Nielsen, N, Niznick, N, Noronha-Falcão, F, Nyquist, P, Olson, D, Othman, M, Owen, A, Padayachy, L, Pajoumand, M, Park, S, Pergakis, M, Perry, H, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puglises, F, Puybasset, L, Rao, C, Rasmussen, L, Rasulo, F, Ray, B, Ricci, Z, Richardson, R, Shinotsuka, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Romagnoli, S, Rosanova, M, Rosenthal, E, Rowe, S, Rubin, M, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosenbaubm, A, Shapshak, A, Sharma, K, Shutter, L, Sitt, J, Slomine, B, Smetana, K, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Stevens, R, Suarez, J, Sung, G, Sussman, B, Taran, S, Mazzeo, A, Thibaut, A, Thompson, D, Threlkeld, Z, Toker, D, Torbey, M, Tosto, J, Trevick, S, Tsaousi, G, Turgeon, A, Udy, A, Varelas, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wahlster, S, Wainwright, M, Whyte, J, Witherspoon, B, Yakhkind, A, Yeager, S, Young, M, Zafar, S, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Zink, E, Tinti, Lorenzo, Lawson, Thomas, Molteni, Erika, Kondziella, Daniel, Rass, Verena, Sharshar, Tarek, Bodien, Yelena G, Giacino, Joseph T, Mayer, Stephan A, Amiri, Moshgan, Muehlschlegel, Susanne, Venkatasubba Rao, Chethan P, Vespa, Paul M, Menon, David K, Citerio, Giuseppe, Helbok, Raimund, McNett, Molly, Agarwal, Sachin, Aiyagari, Venkatesh, Akbari, Yama, Albertson, Asher, Alexander, Sheila, Alexandrov, Anne, Alkhachroum, Ayham, Al-Mufti, Fawaz, Amiri, Moshagan, Appavu, Brian, Gebrewold, Meron Awraris, Ayounb, Marc, Badenes, Rafael, Bader, Mary Kay, Badjiata, Neeraj, Balu, Ram, Barlow, Brooke, Barra, Megan, Beekman, Rachel, Beghi, Ettore, Beqiri, Erta, Berlin, Tracey, Bilotta, Federico, Bleck, Thomas, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Bonnel, Alexandra, Brazzi, Luca, Brown, Emery, Bulic, Sebina, Caceres, Eder, Caceres, Adrian, Cafiero, Tullio, Carroll, Elizabeth, Cediel, Emilio G, Chou, Sherry, Claassen, Jan, Condie, Chad, Conti, Alfredo, Cosmas, Katie, Costa, Paolo, Creutzfeldt, Claire, Dangayach, Neha, Dauri, Mario, Debicki, Derek, DeGeorgia, Michael, Der-Nigoghossian, Caroline, Desai, Masoom, Dhar, Rajat, Diringer, Michael, Durr, Emily, Edlow, Brian, Ercole, Ari, Estraneo, Anna, Falcone, Guido, Farrokh, Salia, Ferguson, Adam, Fernandez-Espejo, Davinia, Fink, Ericka, Fins, Joseph, Foreman, Brandon, Franchi, Federico, Frontera, Jennifer, Ganesan, Rishi, Gaspard, Nicolas, Ghavam, Ahmeneh, Giacino, Joseph, Gibbons, Christie, Gilmore, Emily, Glustein, Chavie, Gosseries, Olivia, Green, Theresa, Greer, David, Guanci, Mary, Gupta, Deepak, Hahn, Cecil, Hakimi, Ryan, Hammond, Flora, Hanley, Daniel F, Hartings, Jed, Hassan, Ahmed, Hemphill, Claude, Da Cunha, Arthur Henrique Galvão Bruno, Hinson, Holly, Hirsch, Karen, Hocker, Sarah, Hu, Peter, Hu, Xiao, Human, Theresa, Hwang, David, Illes, Judy, Jaffa, Matthew, James, Michael L, Janas, Anna, Johnson, Susan, Jones, Morgan, Jox, Ralf J, Kalanuria, Atul, Keller, Emanuela, Kennedy, Lori, Kennelly, Megan, Keogh, Maggie, Kim, Jenn, Kim, Keri, Kirsch, Hannah, Kirschen, Matthew, Ko, Nerissa, Kreitzer, Natalie, Kromm, Julie, Kumar, Abhay, Kurtz, Pedro, Laureys, Steven, Lejeune, Nicolas, Lewis, Ariane, Liang, John, Ling, Geoffrey, Livesay, Sarah, Luppi, Andrea, MacDonald, Jennifer, Maddux, Craig, Mahanes, Dea, Mainali, Shraddha, Maldonado, Nelson, Ribeiro, Rennan Martins, Mascia, Luciana, Massimini, Marcello, Mathur, Rohan, Mayer, Stephan, McCredie, Victoria, Mejia-Mantilla, Jorge, Mendoza, Michael, Menon, David, Meyfroidt, Geert, Mijangos, Julio, Moberg, Dick, Moheet, Asma, Montalenti, Elisa, Monti, Martin, Morrison, Chris, Munar, Marina, Murtaugh, Brooke, Naccache, Lionel, Nagayama, Masao, Nairon, Emerson, Nakagawa, Thomas, Naldi, Andrea, Narenthiran, Ganesalingam, Natarajan, Girija, Nemetsky, Esther, Newcombe, Virginia, Nielsen, Niklas, Niznick, Naomi, Noronha-Falcão, Filipa, Nyquist, Paul, Olson, DaiWai, Othman, Marwan, Owen, Adrian, Padayachy, Llewellyn, Pajoumand, Mehrnaz, Park, Soojin, Pergakis, Melissa, Perry, Heidi, Polizzotto, Len, Pouratian, Nader, Spivack, Marilyn Price, Prisco, Lara, Provencio, Javier, Puglises, Francesco, Puybasset, Louis, Rao, Chethan, Rasmussen, Lindsay, Rasulo, Frank, Ray, Bappaditya, Ricci, Zaccaria, Richardson, Risa, Shinotsuka, Cassia Righy, Robba, Chiara, Robertson, Courtney, Rohaut, Benjamin, Rolston, John, Romagnoli, Stefano, Rosanova, Mario, Rosenthal, Eric, Rowe, Shaun, Rubin, Michael, Russell, Mary Beth, Silva, Gisele Sampaio, Sanz, Leandro, Sarasso, Simone, Sarwal, Aarti, Schiff, Nicolas, Schnakers, Caroline, Seder, David, Shah, Vishank Arun, Shapiro-Rosenbaubm, Amy, Shapshak, Angela, Sharma, Kartavya, Sharma, Kumar Ajay, Shutter, Lori, Sitt, Jacobo, Slomine, Beth, Smetana, Keaton, Smielewski, Peter, Smith, Wade, Stamatakis, Emmanuel, Steinberg, Alexis, Stevens, Robert, Suarez, Jose, Sung, Gene, Sussman, Bethany, Taran, Shaurya, Mazzeo, Anna Teresa, Thibaut, Aurore, Thompson, David, Threlkeld, Zachary, Toker, Daniel, Torbey, Michel, Tosto, Jenna, Trevick, Stephen, Tsaousi, Georgia, Turgeon, Alexis, Udy, Andrew, Varelas, Panos, Vespa, Paul, Videtta, Walter, Voss, Henning, Vox, Ford, Wagner, Amy, Wahlster, Sarah, Wainwright, Mark, Whyte, John, Witherspoon, Briana, Yakhkind, Aleksandra (Sasha), Yeager, Susan, Young, Michael, Zafar, Sahar, Zafonte, Ross, Zahuranec, Darin, Zammit, Chris, Zhang, Bei, Ziai, Wendy, Zimmerman, Lara, Zink, Elizabeth, Tinti, L, Lawson, T, Molteni, E, Kondziella, D, Rass, V, Sharshar, T, Bodien, Y, Giacino, J, Mayer, S, Amiri, M, Muehlschlegel, S, Venkatasubba Rao, C, Vespa, P, Menon, D, Citerio, G, Helbok, R, Mcnett, M, Agarwal, S, Aiyagari, V, Akbari, Y, Albertson, A, Alexander, S, Alexandrov, A, Alkhachroum, A, Al-Mufti, F, Appavu, B, Gebrewold, M, Ayounb, M, Badenes, R, Bader, M, Badjiata, N, Balu, R, Barlow, B, Barra, M, Beekman, R, Beghi, E, Beqiri, E, Berlin, T, Bilotta, F, Bleck, T, Boerwinkle, V, Boly, M, Bonnel, A, Brazzi, L, Brown, E, Bulic, S, Caceres, E, Caceres, A, Cafiero, T, Carroll, E, Cediel, E, Chou, S, Claassen, J, Condie, C, Conti, A, Cosmas, K, Costa, P, Creutzfeldt, C, Dangayach, N, Dauri, M, Debicki, D, Degeorgia, M, Der-Nigoghossian, C, Desai, M, Dhar, R, Diringer, M, Durr, E, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Farrokh, S, Ferguson, A, Fernandez-Espejo, D, Fink, E, Fins, J, Foreman, B, Franchi, F, Frontera, J, Ganesan, R, Gaspard, N, Ghavam, A, Gibbons, C, Gilmore, E, Glustein, C, Gosseries, O, Green, T, Greer, D, Guanci, M, Gupta, D, Hahn, C, Hakimi, R, Hammond, F, Hanley, D, Hartings, J, Hassan, A, Hemphill, C, Da Cunha, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Johnson, S, Jones, M, Jox, R, Kalanuria, A, Keller, E, Kennedy, L, Kennelly, M, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kreitzer, N, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Macdonald, J, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Mascia, L, Massimini, M, Mathur, R, Mccredie, V, Mejia-Mantilla, J, Mendoza, M, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Montalenti, E, Monti, M, Morrison, C, Munar, M, Murtaugh, B, Naccache, L, Nagayama, M, Nairon, E, Nakagawa, T, Naldi, A, Narenthiran, G, Natarajan, G, Nemetsky, E, Newcombe, V, Nielsen, N, Niznick, N, Noronha-Falcão, F, Nyquist, P, Olson, D, Othman, M, Owen, A, Padayachy, L, Pajoumand, M, Park, S, Pergakis, M, Perry, H, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puglises, F, Puybasset, L, Rao, C, Rasmussen, L, Rasulo, F, Ray, B, Ricci, Z, Richardson, R, Shinotsuka, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Romagnoli, S, Rosanova, M, Rosenthal, E, Rowe, S, Rubin, M, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosenbaubm, A, Shapshak, A, Sharma, K, Shutter, L, Sitt, J, Slomine, B, Smetana, K, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Stevens, R, Suarez, J, Sung, G, Sussman, B, Taran, S, Mazzeo, A, Thibaut, A, Thompson, D, Threlkeld, Z, Toker, D, Torbey, M, Tosto, J, Trevick, S, Tsaousi, G, Turgeon, A, Udy, A, Varelas, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wahlster, S, Wainwright, M, Whyte, J, Witherspoon, B, Yakhkind, A, Yeager, S, Young, M, Zafar, S, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Zink, E, Tinti, Lorenzo, Lawson, Thomas, Molteni, Erika, Kondziella, Daniel, Rass, Verena, Sharshar, Tarek, Bodien, Yelena G, Giacino, Joseph T, Mayer, Stephan A, Amiri, Moshgan, Muehlschlegel, Susanne, Venkatasubba Rao, Chethan P, Vespa, Paul M, Menon, David K, Citerio, Giuseppe, Helbok, Raimund, McNett, Molly, Agarwal, Sachin, Aiyagari, Venkatesh, Akbari, Yama, Albertson, Asher, Alexander, Sheila, Alexandrov, Anne, Alkhachroum, Ayham, Al-Mufti, Fawaz, Amiri, Moshagan, Appavu, Brian, Gebrewold, Meron Awraris, Ayounb, Marc, Badenes, Rafael, Bader, Mary Kay, Badjiata, Neeraj, Balu, Ram, Barlow, Brooke, Barra, Megan, Beekman, Rachel, Beghi, Ettore, Beqiri, Erta, Berlin, Tracey, Bilotta, Federico, Bleck, Thomas, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Bonnel, Alexandra, Brazzi, Luca, Brown, Emery, Bulic, Sebina, Caceres, Eder, Caceres, Adrian, Cafiero, Tullio, Carroll, Elizabeth, Cediel, Emilio G, Chou, Sherry, Claassen, Jan, Condie, Chad, Conti, Alfredo, Cosmas, Katie, Costa, Paolo, Creutzfeldt, Claire, Dangayach, Neha, Dauri, Mario, Debicki, Derek, DeGeorgia, Michael, Der-Nigoghossian, Caroline, Desai, Masoom, Dhar, Rajat, Diringer, Michael, Durr, Emily, Edlow, Brian, Ercole, Ari, Estraneo, Anna, Falcone, Guido, Farrokh, Salia, Ferguson, Adam, Fernandez-Espejo, Davinia, Fink, Ericka, Fins, Joseph, Foreman, Brandon, Franchi, Federico, Frontera, Jennifer, Ganesan, Rishi, Gaspard, Nicolas, Ghavam, Ahmeneh, Giacino, Joseph, Gibbons, Christie, Gilmore, Emily, Glustein, Chavie, Gosseries, Olivia, Green, Theresa, Greer, David, Guanci, Mary, Gupta, Deepak, Hahn, Cecil, Hakimi, Ryan, Hammond, Flora, Hanley, Daniel F, Hartings, Jed, Hassan, Ahmed, Hemphill, Claude, Da Cunha, Arthur Henrique Galvão Bruno, Hinson, Holly, Hirsch, Karen, Hocker, Sarah, Hu, Peter, Hu, Xiao, Human, Theresa, Hwang, David, Illes, Judy, Jaffa, Matthew, James, Michael L, Janas, Anna, Johnson, Susan, Jones, Morgan, Jox, Ralf J, Kalanuria, Atul, Keller, Emanuela, Kennedy, Lori, Kennelly, Megan, Keogh, Maggie, Kim, Jenn, Kim, Keri, Kirsch, Hannah, Kirschen, Matthew, Ko, Nerissa, Kreitzer, Natalie, Kromm, Julie, Kumar, Abhay, Kurtz, Pedro, Laureys, Steven, Lejeune, Nicolas, Lewis, Ariane, Liang, John, Ling, Geoffrey, Livesay, Sarah, Luppi, Andrea, MacDonald, Jennifer, Maddux, Craig, Mahanes, Dea, Mainali, Shraddha, Maldonado, Nelson, Ribeiro, Rennan Martins, Mascia, Luciana, Massimini, Marcello, Mathur, Rohan, Mayer, Stephan, McCredie, Victoria, Mejia-Mantilla, Jorge, Mendoza, Michael, Menon, David, Meyfroidt, Geert, Mijangos, Julio, Moberg, Dick, Moheet, Asma, Montalenti, Elisa, Monti, Martin, Morrison, Chris, Munar, Marina, Murtaugh, Brooke, Naccache, Lionel, Nagayama, Masao, Nairon, Emerson, Nakagawa, Thomas, Naldi, Andrea, Narenthiran, Ganesalingam, Natarajan, Girija, Nemetsky, Esther, Newcombe, Virginia, Nielsen, Niklas, Niznick, Naomi, Noronha-Falcão, Filipa, Nyquist, Paul, Olson, DaiWai, Othman, Marwan, Owen, Adrian, Padayachy, Llewellyn, Pajoumand, Mehrnaz, Park, Soojin, Pergakis, Melissa, Perry, Heidi, Polizzotto, Len, Pouratian, Nader, Spivack, Marilyn Price, Prisco, Lara, Provencio, Javier, Puglises, Francesco, Puybasset, Louis, Rao, Chethan, Rasmussen, Lindsay, Rasulo, Frank, Ray, Bappaditya, Ricci, Zaccaria, Richardson, Risa, Shinotsuka, Cassia Righy, Robba, Chiara, Robertson, Courtney, Rohaut, Benjamin, Rolston, John, Romagnoli, Stefano, Rosanova, Mario, Rosenthal, Eric, Rowe, Shaun, Rubin, Michael, Russell, Mary Beth, Silva, Gisele Sampaio, Sanz, Leandro, Sarasso, Simone, Sarwal, Aarti, Schiff, Nicolas, Schnakers, Caroline, Seder, David, Shah, Vishank Arun, Shapiro-Rosenbaubm, Amy, Shapshak, Angela, Sharma, Kartavya, Sharma, Kumar Ajay, Shutter, Lori, Sitt, Jacobo, Slomine, Beth, Smetana, Keaton, Smielewski, Peter, Smith, Wade, Stamatakis, Emmanuel, Steinberg, Alexis, Stevens, Robert, Suarez, Jose, Sung, Gene, Sussman, Bethany, Taran, Shaurya, Mazzeo, Anna Teresa, Thibaut, Aurore, Thompson, David, Threlkeld, Zachary, Toker, Daniel, Torbey, Michel, Tosto, Jenna, Trevick, Stephen, Tsaousi, Georgia, Turgeon, Alexis, Udy, Andrew, Varelas, Panos, Vespa, Paul, Videtta, Walter, Voss, Henning, Vox, Ford, Wagner, Amy, Wahlster, Sarah, Wainwright, Mark, Whyte, John, Witherspoon, Briana, Yakhkind, Aleksandra (Sasha), Yeager, Susan, Young, Michael, Zafar, Sahar, Zafonte, Ross, Zahuranec, Darin, Zammit, Chris, Zhang, Bei, Ziai, Wendy, Zimmerman, Lara, and Zink, Elizabeth
Abstract: Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilit
Published: 2024

4. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Hospital Course, Confounders, and Medications

Author: Barra, M, Zink, E, Bleck, T, Caceres, E, Farrokh, S, Foreman, B, Cediel, E, Hemphill, J, Nagayama, M, Olson, D, Suarez, J, Aiyagari, V, Akbari, Y, Al-Mufti, F, Alexander, S, Alexandrov, A, Alkhachroum, A, Amiri, M, Appavu, B, Gebre, M, Bader, M, Badjiata, N, Balu, R, Beekman, R, Beghi, E, Bell, K, Beqiri, E, Berlin, T, Bodien, Y, Boerwinkle, V, Boly, M, Bonnel, A, Brown, E, Carroll, E, Chou, S, Citerio, G, Classen, J, Condie, C, Cosmas, K, Creutzfeldt, C, Dangayach, N, Degeorgia, M, Der-Nigoghoss, C, Desai, M, Diringer, M, Dullaway, J, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Padayachy, L, Park, S, Pergakis, M, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puybasset, L, Rasmussen, L, Rass, V, Richardson, R, Shinots, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Rosanova, M, Rosenthal, E, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosen, A, Shapshak, A, Sharma, K, Sharshar, T, Shutter, L, Sitt, J, Slomine, B, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Ferioli, S, Fernandez-Esp, D, Fink, E, Fins, J, Frontera, J, Ganesan, R, Ghavam, A, Giacino, J, Gibbons, C, Gilmore, E, Gosseries, O, Green, T, Greer, D, Guanci, M, Hahn, C, Hakimi, R, Hanley, D, Hartings, J, Hassan, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Jones, M, Keller, E, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kondziella, D, Kreitzer, N, Stevens, R, Sussman, B, Taran, S, Thibaut, A, Threlkeld, Z, Tinti, L, Toker, D, Torbey, M, Trevick, S, Turgeon, A, Udy, A, Varelas, P, Venkatasubba, C, Vespa, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wainwright, M, Whyte, J, Witherspoon, B, Yakhind, A, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lawson, T, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Madden, L, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Massimini, M, Mayer, S, Mccredie, V, Mcnett, M, Mejia-Mantill, J, Menon, D, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Molteni, E, Monti, M, Morrison, C, Muehlschlegel, S, Murtaugh, B, Naccache, L, Nairon, E, Natarajan, G, Newcombe, V, Nielsen, N, Noronha-Falc‹, F, Nyquist, P, Othman, M, Owen, A, Barra M. E., Zink E. K., Bleck T. P., Caceres E., Farrokh S., Foreman B., Cediel E. G., Hemphill J. C., Nagayama M., Olson D. W. M., Suarez J. I., Aiyagari V., Akbari Y., Al-Mufti F., Alexander S., Alexandrov A., Alkhachroum A., Amiri M., Appavu B., Gebre M. A., Bader M. K., Badjiata N., Balu R., Beekman R., Beghi E., Bell K., Beqiri E., Berlin T., Bodien Y., Boerwinkle V., Boly M., Bonnel A., Brown E., Carroll E., Chou S., Citerio G., Classen J., Condie C., Cosmas K., Creutzfeldt C., Dangayach N., DeGeorgia M., Der-Nigoghoss C., Desai M., Diringer M., Dullaway J., Edlow B., Ercole A., Estraneo A., Falcone G., Padayachy L., Park S., Pergakis M., Polizzotto L., Pouratian N., Spivack M. P., Prisco L., Provencio J., Puybasset L., Rasmussen L., Rass V., Richardson R., Shinots C. R., Robba C., Robertson C., Rohaut B., Rolston J., Rosanova M., Rosenthal E., Russell M. B., Silva G. S., Sanz L., Sarasso S., Sarwal A., Schiff N., Schnakers C., Seder D., Shah V. A., Shapiro-Rosen A., Shapshak A., Sharma K., Sharshar T., Shutter L., Sitt J., Slomine B., Smielewski P., Smith W., Stamatakis E., Steinberg A., Ferioli S., Fernandez-Esp D., Fink E., Fins J., Frontera J., Ganesan R., Ghavam A., Giacino J., Gibbons C., Gilmore E., Gosseries O., Green T., Greer D., Guanci M., Hahn C., Hakimi R., Hanley D. F., Hartings J., Hassan A., Hinson H., Hirsch K., Hocker S., Hu P., Hu X., Human T., Hwang D., Illes J., Jaffa M., James M. L., Janas A., Jones M., Keller E., Keogh M., Kim J., Kim K., Kirsch H., Kirschen M., Ko N., Kondziella D., Kreitzer N., Stevens R., Sussman B., Taran S., Thibaut A., Threlkeld Z., Tinti L., Toker D., Torbey M., Trevick S., Turgeon A., Udy A., Varelas P., Venkatasubba C., Vespa P., Videtta W., Voss H., Vox F., Wagner A., Wainwright M., Whyte J., Witherspoon B., Yakhind A., Zafonte R., Zahuranec D., Zammit C., Zhang B., Ziai W., Zimmerman L., Kromm J., Kumar A., Kurtz P., Laureys S., Lawson T., Lejeune N., Lewis A., Liang J., Ling G., Livesay S., Luppi A., Madden L., Maddux C., Mahanes D., Mainali S., Maldonado N., Ribeiro R. M., Massimini M., Mayer S., McCredie V., McNett M., Mejia-Mantill J., Menon D., Meyfroidt G., Mijangos J., Moberg D., Moheet A., Molteni E., Monti M., Morrison C., Muehlschlegel S., Murtaugh B., Naccache L., Nairon E., Natarajan G., Newcombe V., Nielsen N., Noronha-Falc‹ F., Nyquist P., Othman M., Owen A., Barra, M, Zink, E, Bleck, T, Caceres, E, Farrokh, S, Foreman, B, Cediel, E, Hemphill, J, Nagayama, M, Olson, D, Suarez, J, Aiyagari, V, Akbari, Y, Al-Mufti, F, Alexander, S, Alexandrov, A, Alkhachroum, A, Amiri, M, Appavu, B, Gebre, M, Bader, M, Badjiata, N, Balu, R, Beekman, R, Beghi, E, Bell, K, Beqiri, E, Berlin, T, Bodien, Y, Boerwinkle, V, Boly, M, Bonnel, A, Brown, E, Carroll, E, Chou, S, Citerio, G, Classen, J, Condie, C, Cosmas, K, Creutzfeldt, C, Dangayach, N, Degeorgia, M, Der-Nigoghoss, C, Desai, M, Diringer, M, Dullaway, J, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Padayachy, L, Park, S, Pergakis, M, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puybasset, L, Rasmussen, L, Rass, V, Richardson, R, Shinots, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Rosanova, M, Rosenthal, E, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosen, A, Shapshak, A, Sharma, K, Sharshar, T, Shutter, L, Sitt, J, Slomine, B, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Ferioli, S, Fernandez-Esp, D, Fink, E, Fins, J, Frontera, J, Ganesan, R, Ghavam, A, Giacino, J, Gibbons, C, Gilmore, E, Gosseries, O, Green, T, Greer, D, Guanci, M, Hahn, C, Hakimi, R, Hanley, D, Hartings, J, Hassan, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Jones, M, Keller, E, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kondziella, D, Kreitzer, N, Stevens, R, Sussman, B, Taran, S, Thibaut, A, Threlkeld, Z, Tinti, L, Toker, D, Torbey, M, Trevick, S, Turgeon, A, Udy, A, Varelas, P, Venkatasubba, C, Vespa, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wainwright, M, Whyte, J, Witherspoon, B, Yakhind, A, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lawson, T, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Madden, L, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Massimini, M, Mayer, S, Mccredie, V, Mcnett, M, Mejia-Mantill, J, Menon, D, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Molteni, E, Monti, M, Morrison, C, Muehlschlegel, S, Murtaugh, B, Naccache, L, Nairon, E, Natarajan, G, Newcombe, V, Nielsen, N, Noronha-Falc‹, F, Nyquist, P, Othman, M, Owen, A, Barra M. E., Zink E. K., Bleck T. P., Caceres E., Farrokh S., Foreman B., Cediel E. G., Hemphill J. C., Nagayama M., Olson D. W. M., Suarez J. I., Aiyagari V., Akbari Y., Al-Mufti F., Alexander S., Alexandrov A., Alkhachroum A., Amiri M., Appavu B., Gebre M. A., Bader M. K., Badjiata N., Balu R., Beekman R., Beghi E., Bell K., Beqiri E., Berlin T., Bodien Y., Boerwinkle V., Boly M., Bonnel A., Brown E., Carroll E., Chou S., Citerio G., Classen J., Condie C., Cosmas K., Creutzfeldt C., Dangayach N., DeGeorgia M., Der-Nigoghoss C., Desai M., Diringer M., Dullaway J., Edlow B., Ercole A., Estraneo A., Falcone G., Padayachy L., Park S., Pergakis M., Polizzotto L., Pouratian N., Spivack M. P., Prisco L., Provencio J., Puybasset L., Rasmussen L., Rass V., Richardson R., Shinots C. R., Robba C., Robertson C., Rohaut B., Rolston J., Rosanova M., Rosenthal E., Russell M. B., Silva G. S., Sanz L., Sarasso S., Sarwal A., Schiff N., Schnakers C., Seder D., Shah V. A., Shapiro-Rosen A., Shapshak A., Sharma K., Sharshar T., Shutter L., Sitt J., Slomine B., Smielewski P., Smith W., Stamatakis E., Steinberg A., Ferioli S., Fernandez-Esp D., Fink E., Fins J., Frontera J., Ganesan R., Ghavam A., Giacino J., Gibbons C., Gilmore E., Gosseries O., Green T., Greer D., Guanci M., Hahn C., Hakimi R., Hanley D. F., Hartings J., Hassan A., Hinson H., Hirsch K., Hocker S., Hu P., Hu X., Human T., Hwang D., Illes J., Jaffa M., James M. L., Janas A., Jones M., Keller E., Keogh M., Kim J., Kim K., Kirsch H., Kirschen M., Ko N., Kondziella D., Kreitzer N., Stevens R., Sussman B., Taran S., Thibaut A., Threlkeld Z., Tinti L., Toker D., Torbey M., Trevick S., Turgeon A., Udy A., Varelas P., Venkatasubba C., Vespa P., Videtta W., Voss H., Vox F., Wagner A., Wainwright M., Whyte J., Witherspoon B., Yakhind A., Zafonte R., Zahuranec D., Zammit C., Zhang B., Ziai W., Zimmerman L., Kromm J., Kumar A., Kurtz P., Laureys S., Lawson T., Lejeune N., Lewis A., Liang J., Ling G., Livesay S., Luppi A., Madden L., Maddux C., Mahanes D., Mainali S., Maldonado N., Ribeiro R. M., Massimini M., Mayer S., McCredie V., McNett M., Mejia-Mantill J., Menon D., Meyfroidt G., Mijangos J., Moberg D., Moheet A., Molteni E., Monti M., Morrison C., Muehlschlegel S., Murtaugh B., Naccache L., Nairon E., Natarajan G., Newcombe V., Nielsen N., Noronha-Falc‹ F., Nyquist P., Othman M., and Owen A.
Abstract: The convergence of an interdisciplinary team of neurocritical care specialists to organize the Curing Coma Campaign is the first effort of its kind to coordinate national and international research efforts aimed at a deeper understanding of disorders of consciousness (DoC). This process of understanding includes translational research from bench to bedside, descriptions of systems of care delivery, diagnosis, treatment, rehabilitation, and ethical frameworks. The description and measurement of varying confounding factors related to hospital care was thought to be critical in furthering meaningful research in patients with DoC. Interdisciplinary hospital care is inherently varied across geographical areas as well as community and academic medical centers. Access to monitoring technologies, specialist consultation (medical, nursing, pharmacy, respiratory, and rehabilitation), staffing resources, specialty intensive and acute care units, specialty medications and specific surgical, diagnostic and interventional procedures, and imaging is variable, and the impact on patient outcome in terms of DoC is largely unknown. The heterogeneity of causes in DoC is the source of some expected variability in care and treatment of patients, which necessitated the development of a common nomenclature and set of data elements for meaningful measurement across studies. Guideline adherence in hemorrhagic stroke and severe traumatic brain injury may also be variable due to moderate or low levels of evidence for many recommendations. This article outlines the process of the development of common data elements for hospital course, confounders, and medications to streamline definitions and variables to collect for clinical studies of DoC.
Published: 2023

5. The lower limit of reactivity as a potential individualised cerebral perfusion pressure target in traumatic brain injury: a CENTER-TBI high-resolution sub-study analysis

Author: Beqiri, E, Zeiler, F, Ercole, A, Placek, M, Tas, J, Donnelly, J, Aries, M, Hutchinson, P, Menon, D, Stocchetti, N, Czosnyka, M, Smielewski, P, Anke, A, Beer, R, Bellander, B, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Beqiri E., Zeiler F. A., Ercole A., Placek M. M., Tas J., Donnelly J., Aries M. J. H., Hutchinson P. J., Menon D., Stocchetti N., Czosnyka M., Smielewski P., Anke A., Beer R., Bellander B. -M., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Beqiri, E, Zeiler, F, Ercole, A, Placek, M, Tas, J, Donnelly, J, Aries, M, Hutchinson, P, Menon, D, Stocchetti, N, Czosnyka, M, Smielewski, P, Anke, A, Beer, R, Bellander, B, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Beqiri E., Zeiler F. A., Ercole A., Placek M. M., Tas J., Donnelly J., Aries M. J. H., Hutchinson P. J., Menon D., Stocchetti N., Czosnyka M., Smielewski P., Anke A., Beer R., Bellander B. -M., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., and Younsi A.
Abstract: Background: A previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort. Methods: Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal–Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong’s test. Results: Average LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP. Conclusions: Using a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.
Published: 2023

6. Towards autoregulation-oriented management after traumatic brain injury: increasing the reliability and stability of the CPPopt algorithm

Author: Beqiri, E, Ercole, A, Aries, M, Placek, M, Tas, J, Czosnyka, M, Stocchetti, N, Smielewski, P, Anke, A, Beer, R, Bellander, B, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler, F, Beqiri E., Ercole A., Aries M. J. H., Placek M. M., Tas J., Czosnyka M., Stocchetti N., Smielewski P., Anke A., Beer R., Bellander B. -M., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Beqiri, E, Ercole, A, Aries, M, Placek, M, Tas, J, Czosnyka, M, Stocchetti, N, Smielewski, P, Anke, A, Beer, R, Bellander, B, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler, F, Beqiri E., Ercole A., Aries M. J. H., Placek M. M., Tas J., Czosnyka M., Stocchetti N., Smielewski P., Anke A., Beer R., Bellander B. -M., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., and Zeiler F. A.
Abstract: Purpose: CPPopt denotes a Cerebral Perfusion Pressure (CPP) value at which the Pressure-Reactivity index, reflecting the global state of Cerebral Autoregulation, is best preserved. CPPopt has been investigated as a potential dynamically individualised CPP target in traumatic brain injury patients admitted in intensive care unit. The prospective bedside use of the concept requires ensured safety and reliability of the CPP recommended targets based on the automatically-generated CPPopt. We aimed to: Increase stability and reliability of the CPPopt automated algorithm by fine-tuning; perform outcome validation of the adjusted algorithm in a multi-centre TBI cohort. Methods: ICM + software was used to derive CPPopt and fine-tune the algorithm. Parameters for improvement of the algorithm were selected based on qualitative and quantitative assessment of stability and reliability metrics. Patients enrolled in the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution cohort were included for retrospective validation. Yield and stability of the new algorithm were compared to the previous algorithm using Mann–U test. Area under the curves for mortality prediction at 6 months were compared with the DeLong Test. Results: CPPopt showed higher stability (p < 0.0001), but lower yield compared to the previous algorithm [80.5% (70—87.5) vs 85% (75.7—91.2), p < 0.001]. Deviation of CPPopt could predict mortality with an AUC of [AUC = 0.69 (95% CI 0.59–0.78), p < 0.001] and was comparable with the previous algorithm. Conclusion: The CPPopt calculation algorithm was fine-tuned and adapted for prospective use with acceptable lower yield, improved stability and maintained prognostic power.
Published: 2023

7. Accuracy of Manual Intracranial Pressure Recording Compared to a Computerized High-Resolution System: A CENTER-TBI Analysis

Author: Zoerle, T, Birg, T, Carbonara, M, Smielewski, P, Placek, M, Zanier, E, Akerlund, C, Ortolano, F, Stocchetti, N, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Depreitere, B, Ercole, A, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler, F, Zoerle T., Birg T., Carbonara M., Smielewski P., Placek M. M., Zanier E. R., Akerlund C. A. I., Ortolano F., Stocchetti N., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Depreitere B., Ercole A., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Zoerle, T, Birg, T, Carbonara, M, Smielewski, P, Placek, M, Zanier, E, Akerlund, C, Ortolano, F, Stocchetti, N, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Depreitere, B, Ercole, A, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler, F, Zoerle T., Birg T., Carbonara M., Smielewski P., Placek M. M., Zanier E. R., Akerlund C. A. I., Ortolano F., Stocchetti N., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Depreitere B., Ercole A., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., and Zeiler F. A.
Abstract: Background: Monitoring intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is crucial in the management of the patient with severe traumatic brain injury (TBI). In several institutions ICP and CPP are summarized hourly and entered manually on bedside charts; these data have been used in large observational and interventional trials. However, ICP and CPP may change rapidly and frequently, so data recorded in medical charts might underestimate actual ICP and CPP shifts. The aim of this study was to evaluate the accuracy of manual data annotation for proper capturing of ICP and CPP. For this aim, we (1) compared end-hour ICP and CPP values manually recorded (MR) with values recorded continuously by computerized high-resolution (HR) systems and (2) analyzed whether MR ICP and MR CPP are reliable indicators of the burden of intracranial hypertension and low CPP. Methods: One hundred patients were included. First, we compared the MR data with the values stored in the computerized system during the first 7 days after admission. For this point-to-point analysis, we calculated the difference between end-hour MR and HR ICP and CPP. Then we analyzed the burden of high ICP (> 20 mm Hg) and low CPP (< 60 mm Hg) measured by the computerized system, in which continuous data were stored, compared with the pressure–time dose based on end-hour measurements. Results: The mean difference between MR and HR end-hour values was 0.02 mm Hg for ICP (SD 3.86 mm Hg) and 1.54 mm Hg for CPP (SD 8.81 mm Hg). ICP > 20 mm Hg and CPP < 60 mm Hg were not detected by MR in 1.6% and 5.8% of synchronized measurements, respectively. Analysis of the pathological ICP and CPP throughout the recording, however, indicated that calculations based on manual recording seriously underestimated the ICP and CPP burden (in 42% and 28% of patients, respectively). Conclusions: Manual entries fairly represent end-hour HR ICP and CPP. However, compared with a computerized system, they may prov
Published: 2023

8. Accuracy of Manual Intracranial Pressure Recording Compared to a Computerized High-Resolution System: A CENTER-TBI Analysis

Author: Zoerle T., Birg T., Carbonara M., Smielewski P., Placek M. M., Zanier E. R., Akerlund C. A. I., Ortolano F., Stocchetti N., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Depreitere B., Ercole A., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Zoerle, T, Birg, T, Carbonara, M, Smielewski, P, Placek, M, Zanier, E, Akerlund, C, Ortolano, F, Stocchetti, N, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Depreitere, B, Ercole, A, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, and Zeiler, F
Subjects: Cerebral perfusion pressure, Traumatic brain injury, Intracranial pressure, Data collection
Abstract: Background: Monitoring intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is crucial in the management of the patient with severe traumatic brain injury (TBI). In several institutions ICP and CPP are summarized hourly and entered manually on bedside charts; these data have been used in large observational and interventional trials. However, ICP and CPP may change rapidly and frequently, so data recorded in medical charts might underestimate actual ICP and CPP shifts. The aim of this study was to evaluate the accuracy of manual data annotation for proper capturing of ICP and CPP. For this aim, we (1) compared end-hour ICP and CPP values manually recorded (MR) with values recorded continuously by computerized high-resolution (HR) systems and (2) analyzed whether MR ICP and MR CPP are reliable indicators of the burden of intracranial hypertension and low CPP. Methods: One hundred patients were included. First, we compared the MR data with the values stored in the computerized system during the first 7 days after admission. For this point-to-point analysis, we calculated the difference between end-hour MR and HR ICP and CPP. Then we analyzed the burden of high ICP (> 20 mm Hg) and low CPP (< 60 mm Hg) measured by the computerized system, in which continuous data were stored, compared with the pressure–time dose based on end-hour measurements. Results: The mean difference between MR and HR end-hour values was 0.02 mm Hg for ICP (SD 3.86 mm Hg) and 1.54 mm Hg for CPP (SD 8.81 mm Hg). ICP > 20 mm Hg and CPP < 60 mm Hg were not detected by MR in 1.6% and 5.8% of synchronized measurements, respectively. Analysis of the pathological ICP and CPP throughout the recording, however, indicated that calculations based on manual recording seriously underestimated the ICP and CPP burden (in 42% and 28% of patients, respectively). Conclusions: Manual entries fairly represent end-hour HR ICP and CPP. However, compared with a computerized system, they may prove inadequate, with a serious risk of underestimation of the ICP and CPP burden.
Published: 2023

9. Towards autoregulation-oriented management after traumatic brain injury: increasing the reliability and stability of the CPPopt algorithm

Author: Beqiri E., Ercole A., Aries M. J. H., Placek M. M., Tas J., Czosnyka M., Stocchetti N., Smielewski P., Anke A., Beer R., Bellander B. -M., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Beqiri, E, Ercole, A, Aries, M, Placek, M, Tas, J, Czosnyka, M, Stocchetti, N, Smielewski, P, Anke, A, Beer, R, Bellander, B, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, and Zeiler, F
Subjects: Cerebral autoregulation, CPPopt, Traumatic brain injury, Multiwindow weighted approach, Reliability, Stability
Abstract: Purpose: CPPopt denotes a Cerebral Perfusion Pressure (CPP) value at which the Pressure-Reactivity index, reflecting the global state of Cerebral Autoregulation, is best preserved. CPPopt has been investigated as a potential dynamically individualised CPP target in traumatic brain injury patients admitted in intensive care unit. The prospective bedside use of the concept requires ensured safety and reliability of the CPP recommended targets based on the automatically-generated CPPopt. We aimed to: Increase stability and reliability of the CPPopt automated algorithm by fine-tuning; perform outcome validation of the adjusted algorithm in a multi-centre TBI cohort. Methods: ICM + software was used to derive CPPopt and fine-tune the algorithm. Parameters for improvement of the algorithm were selected based on qualitative and quantitative assessment of stability and reliability metrics. Patients enrolled in the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution cohort were included for retrospective validation. Yield and stability of the new algorithm were compared to the previous algorithm using Mann–U test. Area under the curves for mortality prediction at 6 months were compared with the DeLong Test. Results: CPPopt showed higher stability (p < 0.0001), but lower yield compared to the previous algorithm [80.5% (70—87.5) vs 85% (75.7—91.2), p < 0.001]. Deviation of CPPopt could predict mortality with an AUC of [AUC = 0.69 (95% CI 0.59–0.78), p < 0.001] and was comparable with the previous algorithm. Conclusion: The CPPopt calculation algorithm was fine-tuned and adapted for prospective use with acceptable lower yield, improved stability and maintained prognostic power.
Published: 2023

10. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Physiology and Big Data

Author: Beqiri, E, Badjatia, N, Ercole, A, Foreman, B, Hu, P, Hu, X, Larovere, K, Meyfroidt, G, Moberg, D, Robba, C, Rosenthal, E, Smielewski, P, Wainwright, M, Park, S, Citerio, G, Beqiri, Erta, Badjatia, Neeraj, Ercole, Ari, Foreman, Brandon, Hu, Peter, Hu, Xiao, LaRovere, Kerri, Meyfroidt, Geert, Moberg, Dick, Robba, Chiara, Rosenthal, Eric, Smielewski, Peter, Wainwright, Mark S, Park, Soojin, Citerio, Giuseppe, Beqiri, E, Badjatia, N, Ercole, A, Foreman, B, Hu, P, Hu, X, Larovere, K, Meyfroidt, G, Moberg, D, Robba, C, Rosenthal, E, Smielewski, P, Wainwright, M, Park, S, Citerio, G, Beqiri, Erta, Badjatia, Neeraj, Ercole, Ari, Foreman, Brandon, Hu, Peter, Hu, Xiao, LaRovere, Kerri, Meyfroidt, Geert, Moberg, Dick, Robba, Chiara, Rosenthal, Eric, Smielewski, Peter, Wainwright, Mark S, Park, Soojin, and Citerio, Giuseppe
Abstract: Background: The implementation of multimodality monitoring in the clinical management of patients with disorders of consciousness (DoC) results in physiological measurements that can be collected in a continuous and regular fashion or even at waveform resolution. Such data are considered part of the “Big Data” available in intensive care units and are potentially suitable for health care-focused artificial intelligence research. Despite the richness in content of the physiological measurements, and the clinical implications shown by derived metrics based on those measurements, they have been largely neglected from previous attempts in harmonizing data collection and standardizing reporting of results as part of common data elements (CDEs) efforts. CDEs aim to provide a framework for unifying data in clinical research and help in implementing a systematic approach that can facilitate reliable comparison of results from clinical studies in DoC as well in international research collaborations. Methods: To address this need, the Neurocritical Care Society’s Curing Coma Campaign convened a multidisciplinary panel of DoC “Physiology and Big Data” experts to propose CDEs for data collection and reporting in this field. Results: We report the recommendations of this CDE development panel and disseminate CDEs to be used in physiologic and big data studies of patients with DoC. Conclusions: These CDEs will support progress in the field of DoC physiologic and big data and facilitate international collaboration.
Published: 2023

11. Systemic Markers of Injury and Injury Response Are Not Associated with Impaired Cerebrovascular Reactivity in Adult Traumatic Brain Injury: A Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study

Author: Zeiler, F, Mathieu, F, Monteiro, M, Glocker, B, Ercole, A, Cabeleira, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Newcombe, V, Menon, D, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundström, N, Takala, R, Tamosuitis, O, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Mathieu F., Monteiro M., Glocker B., Ercole A., Cabeleira M., Stocchetti N., Smielewski P., Czosnyka M., Newcombe V., Menon D. K., Anke A., Beer R., Bellander B. M., Beqiri E., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. O., Kowark A., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundström N., Takala R., Tamosuitis O., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler, F, Mathieu, F, Monteiro, M, Glocker, B, Ercole, A, Cabeleira, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Newcombe, V, Menon, D, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundström, N, Takala, R, Tamosuitis, O, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Mathieu F., Monteiro M., Glocker B., Ercole A., Cabeleira M., Stocchetti N., Smielewski P., Czosnyka M., Newcombe V., Menon D. K., Anke A., Beer R., Bellander B. M., Beqiri E., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. O., Kowark A., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundström N., Takala R., Tamosuitis O., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., and Younsi A.
Abstract: The role of extra-cranial injury burden and systemic injury response on cerebrovascular response in traumatic brain injury (TBI) is poorly documented. This study preliminarily assesses the association between admission features of extra-cranial injury burden on cerebrovascular reactivity. Using the Collaborative European Neurotrauma Effectiveness Research in TBI High-Resolution ICU (HR ICU) sub-study cohort, we evaluated those patients with both archived high-frequency digital intra-parenchymal intra-cranial pressure monitoring data of a minimum of 6 h in duration, and the presence of a digital copy of their admission computed tomography (CT) scan. Digital physiologic signals were processed for pressure reactivity index (PRx) and both the percent time above defined PRx thresholds and mean hourly dose above threshold. This was conducted for both the first 72 h and entire duration of recording. Admission extra-cranial injury characteristics and CT injury scores were obtained from the database, with quantitative contusion, edema, intraventricular hemorrhage, and extra-Axial lesion volumes were obtained via semi-Automated segmentation. Comparison between admission extra-cranial markers of injury and PRx metrics was conducted using Mann-Whitney U testing, and logistic regression techniques, adjusting for known CT injury metrics associated with impaired PRx. A total of 165 patients were included. Evaluating the entire ICU recording period, there was limited association between metrics of extra-cranial injury burden and impaired cerebrovascular reactivity. Using the first 72 h of recording, admission temperature (p = 0.042) and white blood cell % (WBC %; p = 0.013) were statistically associated with impaired cerebrovascular reactivity on Mann-Whitney U and univariate logistic regression. After adjustment for admission age, pupillary status, GCS motor score, pre-hospital hypoxia/hypotension, and intra-cranial CT characteristics associated with impaired reactivity, temperatu
Published: 2021

12. Prediction model for intracranial hypertension demonstrates robust performance during external validation on the CENTER-TBI dataset

Author: Carra, G, Guiza, F, Depreitere, B, Meyfroidt, G, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Ercole, A, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Smielewski, P, Stocchetti, N, Sundstrom, N, Takala, R, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler, F, Carra G., Guiza F., Depreitere B., Meyfroidt G., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Ercole A., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Smielewski P., Stocchetti N., Sundstrom N., Takala R., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Carra, G, Guiza, F, Depreitere, B, Meyfroidt, G, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Ercole, A, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Smielewski, P, Stocchetti, N, Sundstrom, N, Takala, R, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler, F, Carra G., Guiza F., Depreitere B., Meyfroidt G., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Ercole A., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Smielewski P., Stocchetti N., Sundstrom N., Takala R., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., and Zeiler F. A.
Published: 2021

13. Evaluation of the relationship between slow-waves of intracranial pressure, mean arterial pressure and brain tissue oxygen in TBI: a CENTER-TBI exploratory analysis

Author: Zeiler, F, Cabeleira, M, Hutchinson, P, Stocchetti, N, Czosnyka, M, Smielewski, P, Ercole, A, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Cabeleira M., Hutchinson P. J., Stocchetti N., Czosnyka M., Smielewski P., Ercole A., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler, F, Cabeleira, M, Hutchinson, P, Stocchetti, N, Czosnyka, M, Smielewski, P, Ercole, A, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Cabeleira M., Hutchinson P. J., Stocchetti N., Czosnyka M., Smielewski P., Ercole A., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., and Younsi A.
Abstract: Brain tissue oxygen (PbtO2) monitoring in traumatic brain injury (TBI) has demonstrated strong associations with global outcome. Additionally, PbtO2 signals have been used to derive indices thought to be associated with cerebrovascular reactivity in TBI. However, their true relationship to slow-wave vasogenic fluctuations associated with cerebral autoregulation remains unclear. The goal of this study was to investigate the relationship between slow-wave fluctuations of intracranial pressure (ICP), mean arterial pressure (MAP) and PbtO2 over time. Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) high resolution ICU sub-study cohort, we evaluated those patients with recorded high-frequency digital intra-parenchymal ICP and PbtO2 monitoring data of a minimum of 6 h in duration. Digital physiologic signals were processed for ICP, MAP, and PbtO2 slow-waves using a moving average filter to decimate the high-frequency signal. The first 5 days of recording were analyzed. The relationship between ICP, MAP and PbtO2 slow-waves over time were assessed using autoregressive integrative moving average (ARIMA) and vector autoregressive integrative moving average (VARIMA) modelling, as well as Granger causality testing. A total of 47 patients were included. The ARIMA structure of ICP and MAP were similar in time, where PbtO2 displayed different optimal structure. VARIMA modelling and IRF plots confirmed the strong directional relationship between MAP and ICP, demonstrating an ICP response to MAP impulse. PbtO2 slow-waves, however, failed to demonstrate a definite response to ICP and MAP slow-wave impulses. These results raise questions as to the utility of PbtO2 in the derivation of cerebrovascular reactivity measures in TBI. There is a reproducible relationship between slow-wave fluctuations of ICP and MAP, as demonstrated across various time-series analytic techniques. PbtO2 does not appear to reliably respond in
Published: 2021

14. Brain Temperature Influences Intracranial Pressure and Cerebral Perfusion Pressure After Traumatic Brain Injury: A CENTER-TBI Study

Author: Birg T., Ortolano F., Wiegers E. J. A., Smielewski P., Savchenko Y., Ianosi B. A., Helbok R., Rossi S., Carbonara M., Zoerle T., Stocchetti N., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Depreitere B., Ercole A., Frisvold S., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Public Health, HUS Neurocenter, Clinicum, Helsinki University Hospital Area, Neurokirurgian yksikkö, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Rocka, Saulius, Tamosuitis, Tomas, „Springer Nature' grupė, Anke, Audny, Beer, Ronny, Bellander, Bo-Michael, Beqiri, Erta, Buki, Andras, Cabeleira, Manuel, Chieregato, Arturo, Citerio, Giuseppe, Clusmann, Hans, Czeiter, Endre, Czosnyka, Marek, Depreitere, Bart, Ercole, Ari, Frisvold, Shirin, Jankowski, Stefan, Kondziella, Danile, Koskinen, Lars-Owe, Kowark, Ana, Menon, David K., Meyfroidt, Geert, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Raj, Rahul, Rhodes, Jonathan, Rossaint, Rolf, Sahuquillo, Juan, Sakowitz, Oliver, Sundström, Nina, Takala, Riikka, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Stocchetti, Nino [0000-0003-3250-6834], Apollo - University of Cambridge Repository, Birg, T, Ortolano, F, Wiegers, E, Smielewski, P, Savchenko, Y, Ianosi, B, Helbok, R, Rossi, S, Carbonara, M, Zoerle, T, Stocchetti, N, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Depreitere, B, Ercole, A, Frisvold, S, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, and Zeiler, F
Subjects: Neurology, PYREXIA, Intracranial Pressure, MULTICENTER, GUIDELINES, Critical Care and Intensive Care Medicine, Neuromonitoring, 3124 Neurology and psychiatry, 0302 clinical medicine, Traumatic brain injury, Brain Injuries, Traumatic, brain temperature, cerebral perfusion pressure, fever, hyperthermia, intracranial pressure, neuromonitoring, traumatic brain injury, Longitudinal Studies, Prospective Studies, Intracranial pressure, WORSENS, Cerebral perfusion pressure, integumentary system, musculoskeletal, neural, and ocular physiology, CRITICAL-CARE, Temperature, Brain, Cerebrovascular Circulation, Cardiology, medicine.symptom, Life Sciences & Biomedicine, Original Work, Hyperthermia, medicine.medical_specialty, Fever, Clinical Neurology, HYPERTHERMIA, Brain damage, 03 medical and health sciences, Critical Care Medicine, Paired samples, General & Internal Medicine, Internal medicine, RECTAL TEMPERATURES, medicine, Humans, Clinical significance, HEAD, HYPOTHERMIA, Science & Technology, business.industry, 3112 Neurosciences, 030208 emergency & critical care medicine, medicine.disease, nervous system diseases, Brain temperature, Neurosciences & Neurology, Neurology (clinical), Intracranial Hypertension, business, 030217 neurology & neurosurgery
Abstract: Funder: Università degli Studi di Milano, BACKGROUND: After traumatic brain injury (TBI), fever is frequent. Brain temperature (BT), which is directly linked to body temperature, may influence brain physiology. Increased body and/or BT may cause secondary brain damage, with deleterious effects on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcome. METHODS: Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI), a prospective multicenter longitudinal study on TBI in Europe and Israel, includes a high resolution cohort of patients with data sampled at a high frequency (from 100 to 500 Hz). In this study, simultaneous BT, ICP, and CPP recordings were investigated. A mixed-effects linear model was used to examine the association between different BT levels and ICP. We additionally focused on changes in ICP and CPP during the episodes of BT changes (Δ BT ≥ 0.5 °C lasting from 15 min to 3 h) up or downward. The significance of ICP and CPP variations was estimated with the paired samples Wilcoxon test (also known as Wilcoxon signed-rank test). RESULTS: Twenty-one patients with 2,435 h of simultaneous BT and ICP monitoring were studied. All patients reached a BT of 38 °C and experienced at least one episode of ICP above 20 mm Hg. The linear mixed-effects model revealed an association between BT above 37.5 °C and higher ICP levels that was not confirmed for lower BT. We identified 149 episodes of BT changes. During BT elevations (n = 79) ICP increased, whereas CPP was reduced; opposite ICP and CPP variations occurred during episodes of BT reduction (n = 70). All these changes were of moderate clinical relevance (increase of ICP of 4.5 and CPP decrease of 7.5 mm Hg for BT rise, and ICP reduction of 1.7 and CPP elevation of 3.7 mm Hg during BT defervescence), even if statistically significant (p < 0.0001). It has to be noted, however, that a number of therapeutic interventions against intracranial hypertension was documented during those episodes. CONCLUSIONS: Patients after TBI usually develop BT > 38 °C soon after the injury. BT may influence brain physiology, as reflected by ICP and CPP. An association between BT exceeding 37.5 °C and a higher ICP was identified but not confirmed for lower BT ranges. The relationship between BT, ICP, and CPP become clearer during rapid temperature changes. During episodes of temperature elevation, BT seems to have a significant impact on ICP and CPP.
Published: 2021

15. Brain Tissue Oxygen and Cerebrovascular Reactivity in Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Exploratory Analysis of Insult Burden

Author: Zeiler, F, Beqiri, E, Cabeleira, M, Hutchinson, P, Stocchetti, N, Menon, D, Czosnyka, M, Smielewski, P, Ercole, A, Anke, A, Beer, R, Bellander, B, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Meyfroidt, G, Moeller, K, Nelson, D, Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Beqiri E., Cabeleira M., Hutchinson P. J., Stocchetti N., Menon D. K., Czosnyka M., Smielewski P., Ercole A., Anke A., Beer R., Bellander B. -M., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Meyfroidt G., Moeller K., Nelson D., Karjalainen A. P., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler, F, Beqiri, E, Cabeleira, M, Hutchinson, P, Stocchetti, N, Menon, D, Czosnyka, M, Smielewski, P, Ercole, A, Anke, A, Beer, R, Bellander, B, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Meyfroidt, G, Moeller, K, Nelson, D, Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Beqiri E., Cabeleira M., Hutchinson P. J., Stocchetti N., Menon D. K., Czosnyka M., Smielewski P., Ercole A., Anke A., Beer R., Bellander B. -M., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Meyfroidt G., Moeller K., Nelson D., Karjalainen A. P., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., and Younsi A.
Abstract: Pressure reactivity index (PRx) and brain tissue oxygen (PbtO2) are associated with outcome in traumatic brain injury (TBI). This study explores the relationship between PRx and PbtO2 in adult moderate/severe TBI. Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) high resolution intensive care unit (ICU) sub-study cohort, we evaluated those patients with archived high-frequency digital intraparenchymal intracranial pressure (ICP) and PbtO2 monitoring data of, a minimum of 6 h in duration, and the presence of a 6 month Glasgow Outcome Scale -Extended (GOSE) score. Digital physiological signals were processed for ICP, PbtO2, and PRx, with the % time above/below defined thresholds determined. The duration of ICP, PbtO2, and PRx derangements was characterized. Associations with dichotomized 6-month GOSE (alive/dead, and favorable/unfavorable outcome; ≤ 4 = unfavorable), were assessed. A total of 43 patients were included. Severely impaired cerebrovascular reactivity was seen during elevated ICP and low PbtO2 episodes. However, most of the acute ICU physiological derangements were impaired cerebrovascular reactivity, not ICP elevations or low PbtO2 episodes. Low PbtO2 without PRx impairment was rarely seen. % time spent above PRx threshold was associated with mortality at 6 months for thresholds of 0 (area under the curve [AUC] 0.734, p = 0.003), > +0.25 (AUC 0.747, p = 0.002) and > +0.35 (AUC 0.745, p = 0.002). Similar relationships were not seen for % time with ICP >20 mm Hg, and PbtO2 < 20 mm Hg in this cohort. Extreme impairment in cerebrovascular reactivity is seen during concurrent episodes of elevated ICP and low PbtO2. However, the majority of the deranged cerebral physiology seen during the acute ICU phase is impairment in cerebrovascular reactivity, with most impairment occurring in the presence of normal PbtO2 levels. Measures of cerebrovascular reactivity appear to display the most consisten
Published: 2020

16. Descriptive analysis of low versus elevated intracranial pressure on cerebral physiology in adult traumatic brain injury: a CENTER-TBI exploratory study

Author: Zeiler, F, Ercole, A, Cabeleira, M, Stocchetti, N, Hutchinson, P, Smielewski, P, Czosnyka, M, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Ercole A., Cabeleira M., Stocchetti N., Hutchinson P. J., Smielewski P., Czosnyka M., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler, F, Ercole, A, Cabeleira, M, Stocchetti, N, Hutchinson, P, Smielewski, P, Czosnyka, M, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Ercole A., Cabeleira M., Stocchetti N., Hutchinson P. J., Smielewski P., Czosnyka M., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., and Younsi A.
Abstract: Background: To date, the cerebral physiologic consequences of persistently elevated intracranial pressure (ICP) have been based on either low-resolution physiologic data or retrospective high-frequency data from single centers. The goal of this study was to provide a descriptive multi-center analysis of the cerebral physiologic consequences of ICP, comparing those with normal ICP to those with elevated ICP. Methods: The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) High-Resolution Intensive Care Unit (HR-ICU) sub-study cohort was utilized. The first 3 days of physiologic recording were analyzed, evaluating and comparing those patients with mean ICP < 15 mmHg versus those with mean ICP > 20 mmHg. Various cerebral physiologic parameters were derived and evaluated, including ICP, brain tissue oxygen (PbtO2), cerebral perfusion pressure (CPP), pulse amplitude of ICP (AMP), cerebrovascular reactivity, and cerebral compensatory reserve. The percentage time and dose above/below thresholds were also assessed. Basic descriptive statistics were employed in comparing the two cohorts. Results: 185 patients were included, with 157 displaying a mean ICP below 15 mmHg and 28 having a mean ICP above 20 mmHg. For admission demographics, only admission Marshall and Rotterdam CT scores were statistically different between groups (p = 0.017 and p = 0.030, respectively). The high ICP group displayed statistically worse CPP, PbtO2, cerebrovascular reactivity, and compensatory reserve. The high ICP group displayed worse 6-month mortality (p < 0.0001) and poor outcome (p = 0.014), based on the Extended Glasgow Outcome Score. Conclusions: Low versus high ICP during the first 72 h after moderate/severe TBI is associated with significant disparities in CPP, AMP, cerebrovascular reactivity, cerebral compensatory reserve, and brain tissue oxygenation metrics. Such ICP extremes appear to be strongly related to 6-month patient outcomes, in keepin
Published: 2020

17. Association between Cerebrovascular Reactivity Monitoring and Mortality Is Preserved When Adjusting for Baseline Admission Characteristics in Adult Traumatic Brain Injury: A CENTER-TBI Study

Author: Zeiler, F, Ercole, A, Beqiri, E, Cabeleira, M, Thelin, E, Stocchetti, N, Steyerberg, E, Maas, A, Menon, D, Czosnyka, M, Smielewski, P, Citerio, G, Zeiler F. A., Ercole A., Beqiri E., Cabeleira M., Thelin E. P., Stocchetti N., Steyerberg E. W., Maas A. I. R., Menon D. K., Czosnyka M., Smielewski P, Citerio G., Zeiler, F, Ercole, A, Beqiri, E, Cabeleira, M, Thelin, E, Stocchetti, N, Steyerberg, E, Maas, A, Menon, D, Czosnyka, M, Smielewski, P, Citerio, G, Zeiler F. A., Ercole A., Beqiri E., Cabeleira M., Thelin E. P., Stocchetti N., Steyerberg E. W., Maas A. I. R., Menon D. K., Czosnyka M., Smielewski P, and Citerio G.
Abstract: Cerebral autoregulation, as measured using the pressure reactivity index (PRx), has been related to global patient outcome in adult patients with traumatic brain injury (TBI). To date, this has been documented without accounting for standard baseline admission characteristics and intracranial pressure (ICP). We evaluated this association, adjusting for baseline admission characteristics and ICP, in a multi-center, prospective cohort. We derived PRx as the correlation between ICP and mean arterial pressure in prospectively collected multi-center data from the High-Resolution Intensive Care Unit (ICU) cohort of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Multi-variable logistic regression models were analyzed to assess the association between global outcome (measured as either mortality or dichotomized Glasgow Outcome Score-Extended [GOSE]) and a range of covariates (IMPACT [International Mission for Prognosis and Analysis of Clinical Trials] Core and computed tomography [CT] variables, ICP, and PRx). Performance of these models in outcome association was compared using area under the receiver operating curve (AUC) and Nagelkerke's pseudo-R2. One hundred ninety-three patients had a complete data set for analysis. The addition of percent time above threshold for PRx improved AUC and displayed statistically significant increases in Nagelkerke's pseudo-R2 over the IMPACT Core and IMPACT Core + CT models for mortality. The addition of PRx monitoring to IMPACT Core ± CT + ICP models accounted for additional variance in mortality, when compared to models with IMPACT Core ± CT + ICP alone. The addition of cerebrovascular reactivity monitoring, through PRx, provides a statistically significant increase in association with mortality at 6 months. Our data suggest that cerebrovascular reactivity monitoring may provide complementary information regarding outcomes in TBI.
Published: 2020

18. Diffuse Intracranial Injury Patterns Are Associated with Impaired Cerebrovascular Reactivity in Adult Traumatic Brain Injury: A CENTER-TBI Validation Study

Author: Zeiler, F, Mathieu, F, Monteiro, M, Glocker, B, Ercole, A, Beqiri, E, Cabeleira, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Newcombe, V, Menon, D, Citerio, G, Zeiler F. A., Mathieu F., Monteiro M., Glocker B., Ercole A., Beqiri E., Cabeleira M., Stocchetti N., Smielewski P., Czosnyka M., Newcombe V., Menon D. K., Citerio G., Zeiler, F, Mathieu, F, Monteiro, M, Glocker, B, Ercole, A, Beqiri, E, Cabeleira, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Newcombe, V, Menon, D, Citerio, G, Zeiler F. A., Mathieu F., Monteiro M., Glocker B., Ercole A., Beqiri E., Cabeleira M., Stocchetti N., Smielewski P., Czosnyka M., Newcombe V., Menon D. K., and Citerio G.
Abstract: Recent single-center retrospective analysis displayed the association between admission computed tomography (CT) markers of diffuse intracranial injury and worse cerebrovascular reactivity. The goal of this study was to further explore these associations using the prospective multi-center Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) high-resolution intensive care unit (HR ICU) data set. Using the CENTER-TBI HR ICU sub-study cohort, we evaluated those patients with both archived high-frequency digital physiology (100 Hz or higher) and the presence of a digital admission CT scan. Physiological signals were processed for pressure reactivity index (PRx) and both the percent (%) time above defined PRx thresholds and mean hourly dose above threshold. Admission CT injury scores were obtained from the database. Quantitative contusion, edema, intraventricular hemorrhage (IVH), and extra-axial lesion volumes were obtained via semi-automated segmentation. Comparison between admission CT characteristics and PRx metrics was conducted using Mann-U, Jonckheere-Terpstra testing, with a combination of univariate linear and logistic regression techniques. A total of 165 patients were included. Cisternal compression and high admission Rotterdam and Helsinki CT scores, and Marshall CT diffuse injury sub-scores were associated with increased percent (%) time and hourly dose above PRx threshold of 0, +0.25, and +0.35 (p < 0.02 for all). Logistic regression analysis displayed an association between deep peri-contusional edema and mean PRx above a threshold of +0.25. These results suggest that diffuse injury patterns, consistent with acceleration/deceleration forces, are associated with impaired cerebrovascular reactivity. Diffuse admission intracranial injury patterns appear to be consistently associated with impaired cerebrovascular reactivity, as measured through PRx. This is in keeping with the previous single-center retrospective lit
Published: 2020

19. Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: A CENTER-TBI study

Author: Riemann, L, Beqiri, E, Smielewski, P, Czosnyka, M, Stocchetti, N, Sakowitz, O, Zweckberger, K, Unterberg, A, Younsi, A, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Riemann L., Beqiri E., Smielewski P., Czosnyka M., Stocchetti N., Sakowitz O., Zweckberger K., Unterberg A., Younsi A., Anke A., Beer R., Bellander B. -M., Buki A., Chevallard G., Chieregato A., Citerio G., Czeiter E., Depreitere B., Eapen G., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Stevanovic A., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Riemann, L, Beqiri, E, Smielewski, P, Czosnyka, M, Stocchetti, N, Sakowitz, O, Zweckberger, K, Unterberg, A, Younsi, A, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Riemann L., Beqiri E., Smielewski P., Czosnyka M., Stocchetti N., Sakowitz O., Zweckberger K., Unterberg A., Younsi A., Anke A., Beer R., Bellander B. -M., Buki A., Chevallard G., Chieregato A., Citerio G., Czeiter E., Depreitere B., Eapen G., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Stevanovic A., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., and Wolf S.
Abstract: Background: After traumatic brain injury (TBI), brain tissue can be further damaged when cerebral autoregulation is impaired. Managing cerebral perfusion pressure (CPP) according to computed "optimal CPP" values based on cerebrovascular reactivity indices might contribute to preventing such secondary injuries. In this study, we examined the discriminative value of a low-resolution long pressure reactivity index (LPRx) and its derived "optimal CPP" in comparison to the well-established high-resolution pressure reactivity index (PRx). Methods: Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study dataset, the association of LPRx (correlation between 1-min averages of intracranial pressure and arterial blood pressure over a moving time frame of 20 min) and PRx (correlation between 10-s averages of intracranial pressure and arterial blood pressure over a moving time frame of 5 min) to outcome was assessed and compared using univariate and multivariate regression analysis. "Optimal CPP" values were calculated using a multi-window algorithm that was based on either LPRx or PRx, and their discriminative ability was compared. Results: LPRx and PRx were both significant predictors of mortality in univariate and multivariate regression analysis, but PRx displayed a higher discriminative ability. Similarly, deviations of actual CPP from "optimal CPP" values calculated from each index were significantly associated with outcome in univariate and multivariate analysis. "Optimal CPP" based on PRx, however, trended towards more precise predictions. Conclusions: LPRx and its derived "optimal CPP" which are based on low-resolution data were significantly associated with outcome after TBI. However, they did not reach the discriminative ability of the high-resolution PRx and its derived "optimal CPP." Nevertheless, LPRx might still be an interesting tool to assess cerebrovascular reactivity in centers without high-resolution si
Published: 2020

20. Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study

Author: Volovici, V, Pisică, D, Gravesteijn, B, Dirven, C, Steyerberg, E, Ercole, A, Stocchetti, N, Nelson, D, Menon, D, Citerio, G, van der Jagt, M, Maas, A, Haitsma, I, Lingsma, H, Åkerlund, C, Amrein, K, Andelic, N, Andreassen, L, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Beer, R, Bellander, B, Benali, H, Berardino, M, Beretta, L, Beqiri, E, Blaabjerg, M, Lund, S, Brorsson, C, Buki, A, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Lozano, G, Castaño-León, A, Cavallo, S, Chevallard, G, Chieregato, A, Coburn, M, Coles, J, Cooper, J, Correia, M, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, De Keyser, V, Degos, V, Corte, F, Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Dreier, J, Dulière, G, Ezer, E, Fabricius, M, Foks, K, Frisvold, S, Furmanov, A, Galanaud, D, Gantner, D, Ghuysen, A, Giga, L, Golubovic, J, Gomez, P, Grossi, F, Gupta, D, Helseth, E, Hutchinson, P, Jankowski, S, Johnson, F, Karan, M, Kolias, A, Kondziella, D, Koraropoulos, E, Koskinen, L, Kovács, N, Kowark, A, Lagares, A, Laureys, S, Ledoux, D, Lejeune, A, Lightfoot, R, Manara, A, Martino, C, Maréchal, H, Mattern, J, Mcmahon, C, Menovsky, T, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Newcombe, V, Nyirádi, J, Ortolano, F, Payen, J, Perlbarg, V, Persona, P, Piippo-Karjalainen, A, Ples, H, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Richter, S, Rocka, S, Roe, C, Roise, O, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Sahuquillo, J, Sandrød, O, Sakowitz, O, Sanchez-Porras, R, Schirmer-Mikalsen, K, Schou, R, Smielewski, P, Sorinola, A, Stamatakis, E, Sundström, N, Takala, R, Tamás, V, Tamosuitis, T, Tenovuo, O, Thomas, M, Tibboel, D, Tolias, C, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Van der Steen, G, van Wijk, R, Vargiolu, A, Vega, E, Vik, A, Vilcinis, R, Vulekovic, P, Williams, G, Winzeck, S, Wolf, S, Younsi, A, Zeiler, F, Ziverte, A, Clusmann, H, Voormolen, D, van&nbsp, Dijck, J, van Essen, T, Volovici, Victor, Pisică, Dana, Gravesteijn, Benjamin Y., Dirven, Clemens M. F., Steyerberg, Ewout W., Ercole, Ari, Stocchetti, Nino, Nelson, David, Menon, David K., Citerio, Giuseppe, van der Jagt, Mathieu, Maas, Andrew I. R., Haitsma, Iain K., Lingsma, Hester F., Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Beer, Ronny, Bellander, Bo-Michael, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Beqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Brorsson, Camilla, Buki, Andras, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, De Keyser, Véronique, Degos, Vincent, Corte, Francesco Della, Boogert, Hugo den, Depreitere, Bart, Dilvesi, Dula, Dixit, Abhishek, Dreier, Jens, Dulière, Guy-Loup, Ezer, Erzsébet, Fabricius, Martin, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Galanaud, Damien, Gantner, Dashiell, Ghuysen, Alexandre, Giga, Lelde, Golubovic, Jagos, Gomez, Pedro A., Grossi, Francesca, Gupta, Deepak, Haitsma, Iain, Helseth, Eirik, Hutchinson, Peter J., Jankowski, Stefan, Johnson, Faye, Karan, Mladen, Kolias, Angelos G., Kondziella, Daniel, Koraropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Laureys, Steven, Ledoux, Didier, Lejeune, Aurelie, Lightfoot, Roger, Manara, Alex, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Menovsky, Tomas, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Newcombe, Virginia, Nyirádi, József, Ortolano, Fabrizio, Payen, Jean-François, Perlbarg, Vincent, Persona, Paolo, Piippo-Karjalainen, Anna, Ples, Horia, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Richter, Sophie, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Sahuquillo, Juan, Sandrød, Oddrun, Sakowitz, Oliver, Sanchez-Porras, Renan, Schirmer-Mikalsen, Kari, Schou, Rico Frederik, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Tenovuo, Olli, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Trapani, Tony, Tudora, Cristina Maria, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Van der Steen, Gregory, van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Vik, Anne, Vilcinis, Rimantas, Vulekovic, Petar, Williams, Guy, Winzeck, Stefan, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Ziverte, Agate, Clusmann, Hans, Voormolen, Daphne, Dijck, Jeroen T. J. M., van Essen, Thomas A., Volovici, V, Pisică, D, Gravesteijn, B, Dirven, C, Steyerberg, E, Ercole, A, Stocchetti, N, Nelson, D, Menon, D, Citerio, G, van der Jagt, M, Maas, A, Haitsma, I, Lingsma, H, Åkerlund, C, Amrein, K, Andelic, N, Andreassen, L, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Beer, R, Bellander, B, Benali, H, Berardino, M, Beretta, L, Beqiri, E, Blaabjerg, M, Lund, S, Brorsson, C, Buki, A, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Lozano, G, Castaño-León, A, Cavallo, S, Chevallard, G, Chieregato, A, Coburn, M, Coles, J, Cooper, J, Correia, M, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, De Keyser, V, Degos, V, Corte, F, Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Dreier, J, Dulière, G, Ezer, E, Fabricius, M, Foks, K, Frisvold, S, Furmanov, A, Galanaud, D, Gantner, D, Ghuysen, A, Giga, L, Golubovic, J, Gomez, P, Grossi, F, Gupta, D, Helseth, E, Hutchinson, P, Jankowski, S, Johnson, F, Karan, M, Kolias, A, Kondziella, D, Koraropoulos, E, Koskinen, L, Kovács, N, Kowark, A, Lagares, A, Laureys, S, Ledoux, D, Lejeune, A, Lightfoot, R, Manara, A, Martino, C, Maréchal, H, Mattern, J, Mcmahon, C, Menovsky, T, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Newcombe, V, Nyirádi, J, Ortolano, F, Payen, J, Perlbarg, V, Persona, P, Piippo-Karjalainen, A, Ples, H, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Richter, S, Rocka, S, Roe, C, Roise, O, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Sahuquillo, J, Sandrød, O, Sakowitz, O, Sanchez-Porras, R, Schirmer-Mikalsen, K, Schou, R, Smielewski, P, Sorinola, A, Stamatakis, E, Sundström, N, Takala, R, Tamás, V, Tamosuitis, T, Tenovuo, O, Thomas, M, Tibboel, D, Tolias, C, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Van der Steen, G, van Wijk, R, Vargiolu, A, Vega, E, Vik, A, Vilcinis, R, Vulekovic, P, Williams, G, Winzeck, S, Wolf, S, Younsi, A, Zeiler, F, Ziverte, A, Clusmann, H, Voormolen, D, van&nbsp, Dijck, J, van Essen, T, Volovici, Victor, Pisică, Dana, Gravesteijn, Benjamin Y., Dirven, Clemens M. F., Steyerberg, Ewout W., Ercole, Ari, Stocchetti, Nino, Nelson, David, Menon, David K., Citerio, Giuseppe, van der Jagt, Mathieu, Maas, Andrew I. R., Haitsma, Iain K., Lingsma, Hester F., Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Beer, Ronny, Bellander, Bo-Michael, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Beqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Brorsson, Camilla, Buki, Andras, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, De Keyser, Véronique, Degos, Vincent, Corte, Francesco Della, Boogert, Hugo den, Depreitere, Bart, Dilvesi, Dula, Dixit, Abhishek, Dreier, Jens, Dulière, Guy-Loup, Ezer, Erzsébet, Fabricius, Martin, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Galanaud, Damien, Gantner, Dashiell, Ghuysen, Alexandre, Giga, Lelde, Golubovic, Jagos, Gomez, Pedro A., Grossi, Francesca, Gupta, Deepak, Haitsma, Iain, Helseth, Eirik, Hutchinson, Peter J., Jankowski, Stefan, Johnson, Faye, Karan, Mladen, Kolias, Angelos G., Kondziella, Daniel, Koraropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Laureys, Steven, Ledoux, Didier, Lejeune, Aurelie, Lightfoot, Roger, Manara, Alex, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Menovsky, Tomas, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Newcombe, Virginia, Nyirádi, József, Ortolano, Fabrizio, Payen, Jean-François, Perlbarg, Vincent, Persona, Paolo, Piippo-Karjalainen, Anna, Ples, Horia, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Richter, Sophie, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Sahuquillo, Juan, Sandrød, Oddrun, Sakowitz, Oliver, Sanchez-Porras, Renan, Schirmer-Mikalsen, Kari, Schou, Rico Frederik, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Tenovuo, Olli, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Trapani, Tony, Tudora, Cristina Maria, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Van der Steen, Gregory, van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Vik, Anne, Vilcinis, Rimantas, Vulekovic, Petar, Williams, Guy, Winzeck, Stefan, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Ziverte, Agate, Clusmann, Hans, Voormolen, Daphne, Dijck, Jeroen T. J. M., and van Essen, Thomas A.
Abstract: Objective: To compare outcomes between patients with primary external ventricular device (EVD)–driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)–driven treatment. Methods: The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with “center” as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome. Results: A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36–1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34–2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs. Conclusion: We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor–guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group. Protocol: The core study is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (RRID: SCR_015582).
Published: 2022

21. Prediction model for intracranial hypertension demonstrates robust performance during external validation on the CENTER-TBI dataset

Author: Carra G., Guiza F., Depreitere B., Meyfroidt G., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Cabeleira M., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Czosnyka M., Ercole A., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Smielewski P., Stocchetti N., Sundstrom N., Takala R., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler F. A., Carra, G, Guiza, F, Depreitere, B, Meyfroidt, G, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Cabeleira, M, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Czosnyka, M, Ercole, A, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Smielewski, P, Stocchetti, N, Sundstrom, N, Takala, R, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, and Zeiler, F
Subjects: medicine.medical_specialty, business.industry, intracranial hypertension, Anesthesiology, Pain medicine, Emergency medicine, MEDLINE, External validation, Humans, Medicine, Center (algebra and category theory), Critical Care and Intensive Care Medicine, business
Published: 2020

22. Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI analysis

Author: Zeiler, F, Ercole, A, Beqiri, E, Cabeleira, M, Aries, M, Zoerle, T, Carbonara, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Menon, D, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Ercole A., Beqiri E., Cabeleira M., Aries M., Zoerle T., Carbonara M., Stocchetti N., Smielewski P., Czosnyka M., Menon D. K., Anke A., Beer R., Bellander B. -M., Buki A., Chevallard G., Chieregato A., Citerio G., Czeiter E., Depreitere B., Eapen G., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Stevanovic A., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler, F, Ercole, A, Beqiri, E, Cabeleira, M, Aries, M, Zoerle, T, Carbonara, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Menon, D, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Ercole A., Beqiri E., Cabeleira M., Aries M., Zoerle T., Carbonara M., Stocchetti N., Smielewski P., Czosnyka M., Menon D. K., Anke A., Beer R., Bellander B. -M., Buki A., Chevallard G., Chieregato A., Citerio G., Czeiter E., Depreitere B., Eapen G., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Stevanovic A., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., and Younsi A.
Abstract: Background: Impaired cerebrovascular reactivity in adult traumatic brain injury (TBI) is known to be associated with poor outcome. However, there has yet to be an analysis of the association between the comprehensively assessed intracranial hypertension therapeutic intensity level (TIL) and cerebrovascular reactivity. Methods: Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived pressure reactivity index (PRx) as the moving correlation coefficient between slow-wave in ICP and mean arterial pressure, updated every minute. Mean daily PRx, and daily % time above PRx of 0 were calculated for the first 7 days of injury and ICU stay. This data was linked with the daily TIL-Intermediate scores, including total and individual treatment sub-scores. Daily mean PRx variable values were compared for each TIL treatment score via mean, standard deviation, and the Mann U test (Bonferroni correction for multiple comparisons). General fixed effects and mixed effects models for total TIL versus PRx were created to display the relation between TIL and cerebrovascular reactivity. Results: A total of 249 patients with 1230 ICU days of high frequency physiology matched with daily TIL, were assessed. Total TIL was unrelated to daily PRx. Most TIL sub-scores failed to display a significant relationship with the PRx variables. Mild hyperventilation (p < 0.0001), mild hypothermia (p = 0.0001), high levels of sedation for ICP control (p = 0.0001), and use vasopressors for CPP management (p < 0.0001) were found to be associated with only a modest decrease in mean daily PRx or % time with PRx above 0. Conclusions: Cerebrovascular reactivity remains relatively independent of intracranial hypertension therapeutic intensity, suggesting inadequacy of current TBI therapies in modulating impaired autoregulation. These findings support the need for investigation into the molecular mechanisms involved, or i
Published: 2019

23. Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury: a CENTER-TBI validation study

Author: Zeiler, F, Ercole, A, Cabeleira, M, Beqiri, E, Zoerle, T, Carbonara, M, Stocchetti, N, Menon, D, Smielewski, P, Czosnyka, M, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Ercole A., Cabeleira M., Beqiri E., Zoerle T., Carbonara M., Stocchetti N., Menon D. K., Smielewski P., Czosnyka M., Anke A., Beer R., Bellander B. -M., Buki A., Chevallard G., Chieregato A., Citerio G., Czeiter E., Depreitere B., Eapen G., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Stevanovic A., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., Zeiler, F, Ercole, A, Cabeleira, M, Beqiri, E, Zoerle, T, Carbonara, M, Stocchetti, N, Menon, D, Smielewski, P, Czosnyka, M, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Zeiler F. A., Ercole A., Cabeleira M., Beqiri E., Zoerle T., Carbonara M., Stocchetti N., Menon D. K., Smielewski P., Czosnyka M., Anke A., Beer R., Bellander B. -M., Buki A., Chevallard G., Chieregato A., Citerio G., Czeiter E., Depreitere B., Eapen G., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Stevanovic A., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., and Younsi A.
Abstract: Background: Compensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6 months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort. Methods: Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived ICP and wICP (calculated as wICP = (1 − RAP) × ICP; where RAP is the compensatory reserve index derived from the moving correlation between pulse amplitude of ICP and ICP). Various univariate logistic regression models were created comparing ICP and wICP to dichotomized outcome at 6 to 12 months, based on Glasgow Outcome Score—Extended (GOSE) (alive/dead—GOSE ≥ 2/GOSE = 1; favorable/unfavorable—GOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values. Results: wICP displayed higher AUC compared to ICP on univariate regression for alive/dead outcome compared to mean ICP (AUC 0.712, 95% CI 0.615–0.810, p = 0.0002, and AUC 0.642, 95% CI 0.538–746, p < 0.0001, respectively; no significant difference on Delong’s test), and for favorable/unfavorable outcome (AUC 0.627, 95% CI 0.548–0.705, p = 0.015, and AUC 0.495, 95% CI 0.413–0.577, p = 0.059; significantly different using Delong’s test p = 0.002), with lower wICP values associated with improved outcomes (p < 0.05 for both). These relationships on univariate analysis held true even when comparing the wICP models with those containing both ICP and RAP integrated area under the curve over time (p < 0.05 for all via Delong’s test). Conclusions: Compensatory-reserve-weighted ICP displays superior outcome association for both alive/dead and favorable/unfavorable dichotomized o
Published: 2019

24. Descriptive analysis of low versus elevated intracranial pressure on cerebral physiology in adult traumatic brain injury : a CENTER-TBI exploratory study

Author: Zeiler F. A., Ercole A., Cabeleira M., Stocchetti N., Hutchinson P. J., Smielewski P., Czosnyka M., Anke A., Beer R., Bellander B. -M., Beqiri E., Buki A., Carbonara M., Chieregato A., Citerio G., Clusmann H., Czeiter E., Depreitere B., Frisvold S., Helbok R., Jankowski S., Kondziella D., Koskinen L. -O., Kowark A., Menon D. K., Meyfroidt G., Moeller K., Nelson D., Piippo-Karjalainen A., Radoi A., Ragauskas A., Raj R., Rhodes J., Rocka S., Rossaint R., Sahuquillo J., Sakowitz O., Sundstrom N., Takala R., Tamosuitis T., Tenovuo O., Unterberg A., Vajkoczy P., Vargiolu A., Vilcinis R., Wolf S., Younsi A., HUS Neurocenter, Helsinki University Hospital Area, Neurokirurgian yksikkö, Zeiler, F, Ercole, A, Cabeleira, M, Stocchetti, N, Hutchinson, P, Smielewski, P, Czosnyka, M, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Unterberg, A, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, and „Springer' grupė
Subjects: Male, Neurology, Intracranial Pressure, Neurologi, OXYGEN, 3124 Neurology and psychiatry, law.invention, 0302 clinical medicine, Cerebral physiology, Cerebrovascular reactivity, ICP extremes, Outcomes, law, Brain Injuries, Traumatic, Medicine, 030212 general & internal medicine, INDEX, Neuroradiology, Outcome, integumentary system, musculoskeletal, neural, and ocular physiology, Brain, CEREBROVASCULAR REACTIVITY, Middle Aged, AUTOREGULATION, Intensive care unit, humanities, Cerebrovascular Circulation, Cohort, Cardiology, Female, Neurosurgery, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Traumatic brain injury, Clinical Neurology, CLASSIFICATION, 03 medical and health sciences, Original Article - Brain trauma, Internal medicine, MANAGEMENT, Humans, Cerebral perfusion pressure, Aged, Retrospective Studies, Science & Technology, business.industry, 3112 Neurosciences, Oxygenation, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, nervous system diseases, ICP extreme, Surgery, Neurology (clinical), Neurosciences & Neurology, Intracranial Hypertension, business, 030217 neurology & neurosurgery
Abstract: Background To date, the cerebral physiologic consequences of persistently elevated intracranial pressure (ICP) have been based on either low-resolution physiologic data or retrospective high-frequency data from single centers. The goal of this study was to provide a descriptive multi-center analysis of the cerebral physiologic consequences of ICP, comparing those with normal ICP to those with elevated ICP. Methods The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) High-Resolution Intensive Care Unit (HR-ICU) sub-study cohort was utilized. The first 3 days of physiologic recording were analyzed, evaluating and comparing those patients with mean ICP 20 mmHg. Various cerebral physiologic parameters were derived and evaluated, including ICP, brain tissue oxygen (PbtO2), cerebral perfusion pressure (CPP), pulse amplitude of ICP (AMP), cerebrovascular reactivity, and cerebral compensatory reserve. The percentage time and dose above/below thresholds were also assessed. Basic descriptive statistics were employed in comparing the two cohorts. Results 185 patients were included, with 157 displaying a mean ICP below 15 mmHg and 28 having a mean ICP above 20 mmHg. For admission demographics, only admission Marshall and Rotterdam CT scores were statistically different between groups (p = 0.017 and p = 0.030, respectively). The high ICP group displayed statistically worse CPP, PbtO2, cerebrovascular reactivity, and compensatory reserve. The high ICP group displayed worse 6-month mortality (p p = 0.014), based on the Extended Glasgow Outcome Score. Conclusions Low versus high ICP during the first 72 h after moderate/severe TBI is associated with significant disparities in CPP, AMP, cerebrovascular reactivity, cerebral compensatory reserve, and brain tissue oxygenation metrics. Such ICP extremes appear to be strongly related to 6-month patient outcomes, in keeping with previous literature. This work provides multi-center validation for previously described single-center retrospective results.
Published: 2020

25. Association between Cerebrovascular Reactivity Monitoring and Mortality Is Preserved When Adjusting for Baseline Admission Characteristics in Adult Traumatic Brain Injury: A CENTER-TBI Study

Author: Zeiler, F.A., Ercole, A., Beqiri, E., Cabeleira, M., Thelin, E.P., Stocchetti, N., Steyerberg, E.W., Maas, A.I.R., Menon, D.K., Czosnyka, M., Smielewski, P., Anke, A., Beer, R., Helbok, R., Bellander, B.M., Nelson, D., Buki, A., Chevallard, G., Chieregato, A., Citerio, G., Czeiter, E., Depreitere, B., Eapen, G., Frisvold, S., Jankowski, S., Kondziella, D., Koskinen, L.O., Meyfroidt, G., Moeller, K., Piippo-Karjalainen, A., Raj, R., Radoi, A., Sahuquillo, J., Ragauskas, A., Rocka, S., Rhodes, J., Rossaint, R., Stevanovic, A., Sakowitz, O., Sundstrom, N., Takala, R., Tamosuitis, T., Tenovuo, O., Vajkoczy, P., Vargiolu, A., Vilcinis, R., Wolf, S., Younsi, A., CTR-TBI High Resolution ICU HR ICU, Public Health, CTR-TBI High Resolution ICU HR ICU, Zeiler, F, Ercole, A, Beqiri, E, Cabeleira, M, Thelin, E, Stocchetti, N, Steyerberg, E, Maas, A, Menon, D, Czosnyka, M, Smielewski, P, and Citerio, G
Subjects: autoregulation, cerebrovascular reactivity, IMPACT, outcome analysis, Adult, Male, 030506 rehabilitation, medicine.medical_specialty, Neurology, Traumatic brain injury, IMPACT, Cerebral autoregulation, cerebrovascular reactivity, Cohort Studies, outcome analysi, 03 medical and health sciences, 0302 clinical medicine, Cerebrovascular reactivity, Patient Admission, outcome analysis, Brain Injuries, Traumatic, medicine, Humans, Autoregulation, Single-Blind Method, Prospective Studies, Mortality, Adult patients, business.industry, autoregulation, Original Articles, Middle Aged, medicine.disease, 3. Good health, Pressure reactivity, Anesthesia, Cerebrovascular Circulation, Female, Human medicine, Neurology (clinical), Neurosurgery, 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract: Cerebral autoregulation, as measured using the pressure reactivity index (PRx), has been related to global patient outcome in adult patients with traumatic brain injury (TBI). To date, this has been documented without accounting for standard baseline admission characteristics and intracranial pressure (ICP). We evaluated this association, adjusting for baseline admission characteristics and ICP, in a multi-center, prospective cohort. We derived PRx as the correlation between ICP and mean arterial pressure in prospectively collected multi-center data from the High-Resolution Intensive Care Unit (ICU) cohort of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Multi-variable logistic regression models were analyzed to assess the association between global outcome (measured as either mortality or dichotomized Glasgow Outcome Score-Extended [GOSE]) and a range of covariates (IMPACT [International Mission for Prognosis and Analysis of Clinical Trials] Core and computed tomography [CT] variables, ICP, and PRx). Performance of these models in outcome association was compared using area under the receiver operating curve (AUC) and Nagelkerke's pseudo-R-2. One hundred ninety-three patients had a complete data set for analysis. The addition of percent time above threshold for PRx improved AUC and displayed statistically significant increases in Nagelkerke's pseudo-R-2 over the IMPACT Core and IMPACT Core + CT models for mortality. The addition of PRx monitoring to IMPACT Core +/- CT + ICP models accounted for additional variance in mortality, when compared to models with IMPACT Core +/- CT + ICP alone. The addition of cerebrovascular reactivity monitoring, through PRx, provides a statistically significant increase in association with mortality at 6 months. Our data suggest that cerebrovascular reactivity monitoring may provide complementary information regarding outcomes in TBI.
Published: 2019

26. Targeting Autoregulation-Guided Cerebral Perfusion Pressure after Traumatic Brain Injury (COGiTATE): A Feasibility Randomized Controlled Clinical Trial

Author: Tas, J., Beqiri, E., Kaam, R.C. van, Czosnyka, M., Donnelly, J., Haeren, R.H.L., Horst, I.C. van der, Hutchinson, P.J., Kuijk, S.M.J. Van, Liberti, A.L., Menon, D.K., Hoedemaekers, C.W.E., Depreitere, B., Smielewski, P., Meyfroidt, G., Ercole, A., Aries, M.J., Tas, J., Beqiri, E., Kaam, R.C. van, Czosnyka, M., Donnelly, J., Haeren, R.H.L., Horst, I.C. van der, Hutchinson, P.J., Kuijk, S.M.J. Van, Liberti, A.L., Menon, D.K., Hoedemaekers, C.W.E., Depreitere, B., Smielewski, P., Meyfroidt, G., Ercole, A., and Aries, M.J.
Abstract: Item does not contain fulltext, Managing traumatic brain injury (TBI) patients with a cerebral perfusion pressure (CPP) near to the cerebral autoregulation (CA)-guided "optimal" CPP (CPPopt) value is associated with improved outcome and might be useful to individualize care, but has never been prospectively evaluated. This study evaluated the feasibility and safety of CA-guided CPP management in TBI patients requiring intracranial pressure monitoring and therapy (TBIicp patients). The CPPopt Guided Therapy: Assessment of Target Effectiveness (COGiTATE) parallel two-arm feasibility trial took place in four tertiary centers. TBIicp patients were randomized to either the Brain Trauma Foundation (BTF) guideline CPP target range (control group) or to the individualized CA-guided CPP targets (intervention group). CPP targets were guided by six times daily software-based alerts for up to 5 days. The primary feasibility end-point was the percentage of time with CPP concordant (±5 mm Hg) with the set CPP targets. The main secondary safety end-point was an increase in therapeutic intensity level (TIL) between the control and intervention group. Twenty-eight patients were randomized to the control and 32 patients to the intervention group. CPP in the intervention group was in the target range for 46.5% (interquartile range, 41.2-58) of the monitored time, significantly higher than the feasibility target specified in the published protocol (36%; p < 0.001). There were no significant differences between groups for TIL or for other safety end-points. Conclusively, targeting an individual and dynamic CA-guided CPP is feasible and safe in TBIicp patients. This encourages a prospective trial powered for clinical outcomes.
Published: 2021

27. An Update on the COGiTATE Phase II Study: Feasibility and Safety of Targeting an Optimal Cerebral Perfusion Pressure as a Patient-Tailored Therapy in Severe Traumatic Brain Injury

Author: Tas, J., Beqiri, E., Kaam, C.R. van, Ercole, A., Bellen, G., Bruyninckx, D., Cabeleira, M., Czosnyka, M., Depreitere, B., Donnelly, J., Fedriga, M., Hutchinson, P.J., Menon, D., Meyfroidt, G., Liberti, A., Outtrim, J.G., Robba, C., Hoedemaekers, C.W.E., Smielewski, P., Aries, M.J., Tas, J., Beqiri, E., Kaam, C.R. van, Ercole, A., Bellen, G., Bruyninckx, D., Cabeleira, M., Czosnyka, M., Depreitere, B., Donnelly, J., Fedriga, M., Hutchinson, P.J., Menon, D., Meyfroidt, G., Liberti, A., Outtrim, J.G., Robba, C., Hoedemaekers, C.W.E., Smielewski, P., and Aries, M.J.
Abstract: Item does not contain fulltext, INTRODUCTION: Monitoring of cerebral autoregulation (CA) in patients with a traumatic brain injury (TBI) can provide an individual 'optimal' cerebral perfusion pressure (CPP) target (CPPopt) at which CA is best preserved. This potentially offers an individualized precision medicine approach. Retrospective data suggest that deviation of CPP from CPPopt is associated with poor outcomes. We are prospectively assessing the feasibility and safety of this approach in the COGiTATE [CPPopt Guided Therapy: Assessment of Target Effectiveness] study. Its primary objective is to demonstrate the feasibility of individualizing CPP at CPPopt in TBI patients. The secondary objectives are to investigate the safety and physiological effects of this strategy. METHODS: The COGiTATE study has included patients in four European hospitals in Cambridge, Leuven, Nijmegen, and Maastricht (coordinating centre). Patients with severe TBI requiring intracranial pressure (ICP)-directed therapy are allocated into one of two groups. In the intervention group, CPPopt is calculated using a published (modified) algorithm. In the control group, the CPP target recommended in the Brain Trauma Foundation guidelines (CPP 60-70 mmHg) is used. RESULTS: Patient recruitment started in February 2018 and will continue until 60 patients have been studied. Fifty-one patients (85% of the intended total) have been recruited in October 2019. The first results are expected early 2021. CONCLUSION: This prospective evaluation of the feasibility, safety and physiological implications of autoregulation-guided CPP management is providing evidence that will be useful in the design of a future phase III study in severe TBI patients.
Published: 2021

28. Anti-decubitus bed mattress may interfere with cerebrovascular pressure reactivity measures due to induced ICP and ABP cyclic peaks

Author: Jeanette, T., Jeanette, T., Borg, Melisa, Smielewski, Peter, Czosnyka, Marek, Beqiri, E., Ari, E., Marcel, A., Jeanette, T., Jeanette, T., Borg, Melisa, Smielewski, Peter, Czosnyka, Marek, Beqiri, E., Ari, E., and Marcel, A.
Abstract: Severe traumatic brain injury (TBI) patients are monitored with continuous arterial blood pressure (ABP) and intracranial pressure (ICP). The pressure reactivity index (PRx) is a frequently used correlation coefficient between ABP and ICP to inform clinicians at the bedside about trends in global cerebrovascular pressure regulation status. We present an unexpected influence of cyclic anti-decubitus mattress inflations and deflations on invasive ICP, ABP and PRx calculations in our TBI patients. This might affect autoregulation guided management. In our database, 23% (9/39) of the patients show recurrent peaks in the monitoring signals. We hypothesize that these peaks are caused by (a combination) of hydrostatic change, local (cervical) compression and/or incorrect sensor zeroing due to positional changes induced by the anti-decubitus mattress. This warrants further investigation by the manufacturer and exploration of data filters.
Published: 2021

29. The mineral base and productive capacities of metals and non-metals of Kosovo

Author: Rizaj, M., Beqiri, E., McBow, I., O’Brien, E. Z., and Kongoli, F.
Published: 2008
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30. Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe

Author: Huijben, A.L.C.J.R.M. (Jilske), Wiegers-Groeneweg, E.J.A. (Eveline), Lingsma, H.F. (Hester), Citerio, G. (Giuseppe), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Ercole, A. (Ari), Nelson, D. (David), Jagt, M. (Mathieu) van der, Steyerberg, E.W. (Ewout), Helbok, R. (Raimund), Lecky, F.E. (Fiona), Peul, W.C. (Wilco), Birg, T. (Tatiana), Zoerle, T. (Tommaso), Carbonara, M. (Marco), Stocchetti, N. (Nino), Åkerlund, C. (Cecilia), Amrein, K. (Krisztina), Andelic, N. (Nada), Andreassen, L. (Lasse), Audibert, G. (Gérard), Azouvi, P. (Philippe), Azzolini, M.L. (Maria Luisa), Bartels, R.H.M.A. (Ronald), Beer, R. (Ronny), Bellander, B.-M. (Bo-Michael), Benali, H. (Habib), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beqiri, E. (Erta), Blaabjerg, M. (Morten), Lund, S.B. (Stine Borgen), Brorsson, C. (Camilla), Buki, A. (Andras), Cabeleira, M. (Manuel), Caccioppola, A. (Alessio), Calappi, E. (Emiliana), Calvi, M.R. (Maria Rosa), Cameron, P. (Peter), Lozano, G.C. (Guillermo Carbayo), Castaño-León, A.M. (Ana M.), Cavallo, S. (Simona), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Dark, P. (Paul), DeKeyser, V. (Véronique), Degos, V. (Vincent), Della Corte, F. (Francesco), den Boogert, H. (Hugo), Depreitere, B. (Bart), Dilvesi, D. (Dula), Dixit, A. (Abhishek), Dreier, J.P. (Jens), Dulière, G.-L. (Guy-Loup), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Foks, K. (Kelly), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Galanaud, D. (Damien), Gantner, D. (Dashiell), Ghuysen, A. (Alexandre), Giga, L. (Lelde), Golubovic, J. (Jagos), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gupta, D. (Deepak), Haitsma, I. (Iain), Helseth, E. (Eirik), Hutchinson, P.J. (Peter J.), Jankowski, S. (Stefan), Johnson, F. (Faye), Karan, M. (Mladen), Kolias, A.G. (Angelos G.), Kondziella, D. (Daniel), Koraropoulos, E. (Evgenios), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kowark, A. (Ana), Lagares, A. (Alfonso), Laureys, S. (Steven), Ledoux, D. (Didier), Lejeune, A. (Aurelie), Lightfoot, R. (Roger), Manara, A. (Alex), Martino, C. (Costanza), Maréchal, H. (Hugues), Mattern, J. (Julia), McMahon, C. (Catherine), Menovsky, T. (Tomas), Misset, B. (Benoit), Muraleedharan, V. (Visakh), Murray, L. (Lynnette), Negru, A. (Ancuta), Newcombe, V.F. (Virginia F.), Nyirádi, J. (József), Ortolano, F. (Fabrizio), Payen, J.-F. (Jean-François), Perlbarg, V. (Vincent), Persona, P. (Paolo), Piippo-Karjalainen, A. (Anna), Ples, H. (Horia), Pomposo, I. (Inigo), Posti, J.P. (Jussi P.), Puybasset, L. (Louis), Radoi, A. (Andreea), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rhodes, J.K.J. (Jonathan K.J.), Richter, S. (Sophie), Rocka, S. (Saulius), Roe, C. (Cecilie), Roise, O. (Olav), Rosenfeld, J.V. (Jeffrey V.), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Sahuquillo, J. (Juan), Sandrød, O. (Oddrun), Sakowitz, O. (Oliver), Sanchez-Porras, R. (Renan), Schirmer-Mikalsen, K. (Kari), Schou, R. (Rico), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E. (Emmanuel), Sundström, N. (Nina), Takala, R. (Riikka), Tamás, V. (Viktória), Tamosuitis, T. (Tomas), Tenovuo, O. (Olli), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Trapani, T. (Tony), Tudora, C.M. (CristinaMaria), Vajkoczy, P. (Peter), Vallance, S. (Shirley), Valeinis, E. (Egils), Vámos, Z. (Zoltán), Van der Steen, G. (Gregory), van Wijk, R.P.J. (Roel P. J.), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Vik, A. (Anne), Vilcinis, R. (Rimantas), Volovici, V. (Victor), Vulekovic, P. (Peter), Williams, G. (Guy), Winzeck, S. (Stefan), Wolf, S. (Stefan), Younsi, A. (Alexander), Zeiler, F.A. (Frederick A.), Clusmann, A.Z.H. (Agate Ziverte Hans), Voormolen, D.C. (Daphne), van Dijck, J.T.J.M. (Jeroen T. J. M.), van Essen, T.A. (Thomas A.), Huijben, A.L.C.J.R.M. (Jilske), Wiegers-Groeneweg, E.J.A. (Eveline), Lingsma, H.F. (Hester), Citerio, G. (Giuseppe), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Ercole, A. (Ari), Nelson, D. (David), Jagt, M. (Mathieu) van der, Steyerberg, E.W. (Ewout), Helbok, R. (Raimund), Lecky, F.E. (Fiona), Peul, W.C. (Wilco), Birg, T. (Tatiana), Zoerle, T. (Tommaso), Carbonara, M. (Marco), Stocchetti, N. (Nino), Åkerlund, C. (Cecilia), Amrein, K. (Krisztina), Andelic, N. (Nada), Andreassen, L. (Lasse), Audibert, G. (Gérard), Azouvi, P. (Philippe), Azzolini, M.L. (Maria Luisa), Bartels, R.H.M.A. (Ronald), Beer, R. (Ronny), Bellander, B.-M. (Bo-Michael), Benali, H. (Habib), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beqiri, E. (Erta), Blaabjerg, M. (Morten), Lund, S.B. (Stine Borgen), Brorsson, C. (Camilla), Buki, A. (Andras), Cabeleira, M. (Manuel), Caccioppola, A. (Alessio), Calappi, E. (Emiliana), Calvi, M.R. (Maria Rosa), Cameron, P. (Peter), Lozano, G.C. (Guillermo Carbayo), Castaño-León, A.M. (Ana M.), Cavallo, S. (Simona), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Dark, P. (Paul), DeKeyser, V. (Véronique), Degos, V. (Vincent), Della Corte, F. (Francesco), den Boogert, H. (Hugo), Depreitere, B. (Bart), Dilvesi, D. (Dula), Dixit, A. (Abhishek), Dreier, J.P. (Jens), Dulière, G.-L. (Guy-Loup), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Foks, K. (Kelly), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Galanaud, D. (Damien), Gantner, D. (Dashiell), Ghuysen, A. (Alexandre), Giga, L. (Lelde), Golubovic, J. (Jagos), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gupta, D. (Deepak), Haitsma, I. (Iain), Helseth, E. (Eirik), Hutchinson, P.J. (Peter J.), Jankowski, S. (Stefan), Johnson, F. (Faye), Karan, M. (Mladen), Kolias, A.G. (Angelos G.), Kondziella, D. (Daniel), Koraropoulos, E. (Evgenios), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kowark, A. (Ana), Lagares, A. (Alfonso), Laureys, S. (Steven), Ledoux, D. (Didier), Lejeune, A. (Aurelie), Lightfoot, R. (Roger), Manara, A. (Alex), Martino, C. (Costanza), Maréchal, H. (Hugues), Mattern, J. (Julia), McMahon, C. (Catherine), Menovsky, T. (Tomas), Misset, B. (Benoit), Muraleedharan, V. (Visakh), Murray, L. (Lynnette), Negru, A. (Ancuta), Newcombe, V.F. (Virginia F.), Nyirádi, J. (József), Ortolano, F. (Fabrizio), Payen, J.-F. (Jean-François), Perlbarg, V. (Vincent), Persona, P. (Paolo), Piippo-Karjalainen, A. (Anna), Ples, H. (Horia), Pomposo, I. (Inigo), Posti, J.P. (Jussi P.), Puybasset, L. (Louis), Radoi, A. (Andreea), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rhodes, J.K.J. (Jonathan K.J.), Richter, S. (Sophie), Rocka, S. (Saulius), Roe, C. (Cecilie), Roise, O. (Olav), Rosenfeld, J.V. (Jeffrey V.), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Sahuquillo, J. (Juan), Sandrød, O. (Oddrun), Sakowitz, O. (Oliver), Sanchez-Porras, R. (Renan), Schirmer-Mikalsen, K. (Kari), Schou, R. (Rico), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E. (Emmanuel), Sundström, N. (Nina), Takala, R. (Riikka), Tamás, V. (Viktória), Tamosuitis, T. (Tomas), Tenovuo, O. (Olli), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Trapani, T. (Tony), Tudora, C.M. (CristinaMaria), Vajkoczy, P. (Peter), Vallance, S. (Shirley), Valeinis, E. (Egils), Vámos, Z. (Zoltán), Van der Steen, G. (Gregory), van Wijk, R.P.J. (Roel P. J.), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Vik, A. (Anne), Vilcinis, R. (Rimantas), Volovici, V. (Victor), Vulekovic, P. (Peter), Williams, G. (Guy), Winzeck, S. (Stefan), Wolf, S. (Stefan), Younsi, A. (Alexander), Zeiler, F.A. (Frederick A.), Clusmann, A.Z.H. (Agate Ziverte Hans), Voormolen, D.C. (Daphne), van Dijck, J.T.J.M. (Jeroen T. J. M.), and van Essen, T.A. (Thomas A.)
Abstract: Purpose: To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. Methods: This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. Results: A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13–15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p < 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p < 0.001) and aggressive treatmen
Published: 2020
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31. Quality indicators for patients with traumatic brain injury in European intensive care units

Author: Huijben, A.L.C.J.R.M. (Jilske), Wiegers-Groeneweg, E.J.A. (Eveline), Ercole, A. (Ari), Keizer, N.F. (Nicolette) de, Maas, A.I.R. (Andrew), Steyerberg, E.W. (Ewout), Citerio, G. (Giuseppe), Wilson, L. (Lindsay), Polinder, S. (Suzanne), Nieboer, D. (Daan), Menon, D.K. (David ), Lingsma, H.F. (Hester), Jagt, M. (Mathieu) van der, Åkerlund, C. (Cecilia), Amrein, K. (Krisztina), Andelic, N. (Nada), Andreassen, L. (Lasse), Audibert, G. (Gérard), Azouvi, P. (Philippe), Azzolini, M.L. (Maria Luisa), Bartels, R.H.M.A. (Ronald), Beer, R. (Ronny), Bellander, B.-M. (Bo-Michael), Benali, H. (Habib), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beqiri, E. (Erta), Blaabjerg, M. (Morten), Lund, S.B. (Stine Borgen), Brorsson, C. (Camilla), Buki, A. (Andras), Cabeleira, M. (Manuel), Caccioppola, A. (Alessio), Calappi, E. (Emiliana), Calvi, M.R. (Maria Rosa), Cameron, P. (Peter), Lozano, G.C. (Guillermo Carbayo), Carbonara, M. (Marco), Castaño-León, A.M. (Ana M.), Cavallo, S. (Simona), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Dark, P. (Paul), De Keyser, V. (Véronique), Degos, V. (Vincent), Corte, F.D. (Francesco Della), Den Boogert, H. (Hugo), Depreitere, B. (Bart), Dilvesi, D. (Dula), Dixit, A. (Abhishek), Dreier, J.P. (Jens), Dulière, G.-L. (Guy-Loup), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Foks, K. (Kelly), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Galanaud, D. (Damien), Gantner, D. (Dashiell), Ghuysen, A. (Alexandre), Giga, L. (Lelde), Golubovic, J. (Jagos), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gupta, D. (Deepak), Haitsma, I. (Iain), Helbok, R. (Raimund), Helseth, E. (Eirik), Hutchinson, P.J. (Peter J.), Jankowski, S. (Stefan), Johnson, F. (Faye), Karan, M. (Mladen), Kolias, A.G. (Angelos G.), Kondziella, D. (Daniel), Koraropoulos, E. (Evgenios), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kowark, A. (Ana), Lagares, A. (Alfonso), Laureys, S. (Steven), Lecky, F.E. (Fiona), Ledoux, D. (Didier), Lejeune, A. (Aurelie), Lightfoot, R. (Roger), Manara, A. (Alex), Martino, C. (Costanza), Maréchal, H. (Hugues), Mattern, J. (Julia), McMahon, C. (Catherine), Menovsky, T. (Tomas), Misset, B. (Benoit), Muraleedharan, V. (Visakh), Murray, L. (Lynnette), Negru, A. (Ancuta), Nelson, D. (David), Newcombe, V.F. (Virginia F.), Nyirádi, J. (József), Ortolano, F. (Fabrizio), Payen, J.-F. (Jean-François), Perlbarg, V. (Vincent), Persona, P. (Paolo), Peul, W.C. (Wilco), Piippo-Karjalainen, A. (Anna), Ples, H. (Horia), Pomposo, I. (Inigo), Posti, J.P. (Jussi P.), Puybasset, L. (Louis), Radoi, A. (Andreea), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rhodes, J.K.J. (Jonathan K.J.), Richter, S. (Sophie), Rocka, S. (Saulius), Roe, C. (Cecilie), Roise, O. (Olav), Rosenfeld, J.V. (Jeffrey V.), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Sahuquillo, J. (Juan), Sandrød, O. (Oddrun), Sakowitz, O. (Oliver), Sanchez-Porras, R. (Renan), Schirmer-Mikalsen, K. (Kari), Schou, R. (Rico), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E. (Emmanuel), Stocchetti, N. (Nino), Sundström, N. (Nina), Takala, R. (Riikka), Tamás, V. (Viktória), Tamosuitis, T. (Tomas), Tenovuo, O. (Olli), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Trapani, T. (Tony), Tudora, C.M. (Cristina Maria), Vajkoczy, P. (Peter), Vallance, S. (Shirley), Valeinis, E. (Egils), Vámos, Z. (Zoltán), Van Der Steen, G. (Gregory), Van Dijck, J.T.J.M. (Jeroen T. J. M.), Van Essen, T.A. (Thomas A.), Van Wijk, R.P.J. (Roel P. J.), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Vik, A. (Anne), Vilcinis, R. (Rimantas), Volovici, V. (Victor), Voormolen, D.C. (Daphne), Vulekovic, P. (Peter), Williams, G. (Guy), Winzeck, S. (Stefan), Wolf, S. (Stefan), Younsi, A. (Alexander), Zeiler, F.A. (Frederick A.), Ziverte, A. (Agate), Zoerle, T. (Tommaso), Clusmann, H. (Hans), Huijben, A.L.C.J.R.M. (Jilske), Wiegers-Groeneweg, E.J.A. (Eveline), Ercole, A. (Ari), Keizer, N.F. (Nicolette) de, Maas, A.I.R. (Andrew), Steyerberg, E.W. (Ewout), Citerio, G. (Giuseppe), Wilson, L. (Lindsay), Polinder, S. (Suzanne), Nieboer, D. (Daan), Menon, D.K. (David ), Lingsma, H.F. (Hester), Jagt, M. (Mathieu) van der, Åkerlund, C. (Cecilia), Amrein, K. (Krisztina), Andelic, N. (Nada), Andreassen, L. (Lasse), Audibert, G. (Gérard), Azouvi, P. (Philippe), Azzolini, M.L. (Maria Luisa), Bartels, R.H.M.A. (Ronald), Beer, R. (Ronny), Bellander, B.-M. (Bo-Michael), Benali, H. (Habib), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beqiri, E. (Erta), Blaabjerg, M. (Morten), Lund, S.B. (Stine Borgen), Brorsson, C. (Camilla), Buki, A. (Andras), Cabeleira, M. (Manuel), Caccioppola, A. (Alessio), Calappi, E. (Emiliana), Calvi, M.R. (Maria Rosa), Cameron, P. (Peter), Lozano, G.C. (Guillermo Carbayo), Carbonara, M. (Marco), Castaño-León, A.M. (Ana M.), Cavallo, S. (Simona), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Dark, P. (Paul), De Keyser, V. (Véronique), Degos, V. (Vincent), Corte, F.D. (Francesco Della), Den Boogert, H. (Hugo), Depreitere, B. (Bart), Dilvesi, D. (Dula), Dixit, A. (Abhishek), Dreier, J.P. (Jens), Dulière, G.-L. (Guy-Loup), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Foks, K. (Kelly), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Galanaud, D. (Damien), Gantner, D. (Dashiell), Ghuysen, A. (Alexandre), Giga, L. (Lelde), Golubovic, J. (Jagos), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gupta, D. (Deepak), Haitsma, I. (Iain), Helbok, R. (Raimund), Helseth, E. (Eirik), Hutchinson, P.J. (Peter J.), Jankowski, S. (Stefan), Johnson, F. (Faye), Karan, M. (Mladen), Kolias, A.G. (Angelos G.), Kondziella, D. (Daniel), Koraropoulos, E. (Evgenios), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kowark, A. (Ana), Lagares, A. (Alfonso), Laureys, S. (Steven), Lecky, F.E. (Fiona), Ledoux, D. (Didier), Lejeune, A. (Aurelie), Lightfoot, R. (Roger), Manara, A. (Alex), Martino, C. (Costanza), Maréchal, H. (Hugues), Mattern, J. (Julia), McMahon, C. (Catherine), Menovsky, T. (Tomas), Misset, B. (Benoit), Muraleedharan, V. (Visakh), Murray, L. (Lynnette), Negru, A. (Ancuta), Nelson, D. (David), Newcombe, V.F. (Virginia F.), Nyirádi, J. (József), Ortolano, F. (Fabrizio), Payen, J.-F. (Jean-François), Perlbarg, V. (Vincent), Persona, P. (Paolo), Peul, W.C. (Wilco), Piippo-Karjalainen, A. (Anna), Ples, H. (Horia), Pomposo, I. (Inigo), Posti, J.P. (Jussi P.), Puybasset, L. (Louis), Radoi, A. (Andreea), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rhodes, J.K.J. (Jonathan K.J.), Richter, S. (Sophie), Rocka, S. (Saulius), Roe, C. (Cecilie), Roise, O. (Olav), Rosenfeld, J.V. (Jeffrey V.), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Sahuquillo, J. (Juan), Sandrød, O. (Oddrun), Sakowitz, O. (Oliver), Sanchez-Porras, R. (Renan), Schirmer-Mikalsen, K. (Kari), Schou, R. (Rico), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E. (Emmanuel), Stocchetti, N. (Nino), Sundström, N. (Nina), Takala, R. (Riikka), Tamás, V. (Viktória), Tamosuitis, T. (Tomas), Tenovuo, O. (Olli), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Trapani, T. (Tony), Tudora, C.M. (Cristina Maria), Vajkoczy, P. (Peter), Vallance, S. (Shirley), Valeinis, E. (Egils), Vámos, Z. (Zoltán), Van Der Steen, G. (Gregory), Van Dijck, J.T.J.M. (Jeroen T. J. M.), Van Essen, T.A. (Thomas A.), Van Wijk, R.P.J. (Roel P. J.), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Vik, A. (Anne), Vilcinis, R. (Rimantas), Volovici, V. (Victor), Voormolen, D.C. (Daphne), Vulekovic, P. (Peter), Williams, G. (Guy), Winzeck, S. (Stefan), Wolf, S. (Stefan), Younsi, A. (Alexander), Zeiler, F.A. (Frederick A.), Ziverte, A. (Agate), Zoerle, T. (Tommaso), and Clusmann, H. (Hans)
Abstract: Background: The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Methods: Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10. Results: A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre. Conclusions: Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators. Trial registration: The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
Published: 2020
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32. Concentration and distribution characteristics of Trepca shaft furnace slag.

Author: Rizaj M., European metallurgical conference: EMC 2007, Dusseldorf, Germany, 11-14 June 2007, Beqiri E., Kamberaj N., Terziqi A., Rizaj M., European metallurgical conference: EMC 2007, Dusseldorf, Germany, 11-14 June 2007, Beqiri E., Kamberaj N., and Terziqi A.
Abstract: The slag produced during the smelting of agglomerates in the Pb shaft furnaces at Trepca in Kosovo contains considerable amounts of valuable metals such as Pb, Zn, Bi, Ag and Au. The amount of slag deposited around the smelters is estimated to be 2 500 000-3 000 000 tonnes and has potential for use as raw material for Pb production and for the extraction of valuable metals. Measurements were made of slag composition over a one-year period and statistical analyses carried out of the concentration and distribution of the components in the slag and their shape characteristics. The Pb concentration in the slag exhibited considerable variations, indicating irregularities in the furnace operations; reduced Pb contents may be achieved by maintaining constant furnace operating conditions., The slag produced during the smelting of agglomerates in the Pb shaft furnaces at Trepca in Kosovo contains considerable amounts of valuable metals such as Pb, Zn, Bi, Ag and Au. The amount of slag deposited around the smelters is estimated to be 2 500 000-3 000 000 tonnes and has potential for use as raw material for Pb production and for the extraction of valuable metals. Measurements were made of slag composition over a one-year period and statistical analyses carried out of the concentration and distribution of the components in the slag and their shape characteristics. The Pb concentration in the slag exhibited considerable variations, indicating irregularities in the furnace operations; reduced Pb contents may be achieved by maintaining constant furnace operating conditions.
Published: 2007

33. The lower limit of reactivity as a potential individualised cerebral perfusion pressure target in traumatic brain injury: a CENTER-TBI high-resolution sub-study analysis

Author: Beqiri, Erta, Zeiler, Frederick A, Ercole, Ari, Placek, Michal M, Tas, Jeanette, Donnelly, Joseph, Aries, Marcel JH, Hutchinson, Peter J, Menon, David, Stocchetti, Nino, Czosnyka, Marek, Smielewski, Peter, CENTER-TBI HR ICU participants and investigators, Beqiri, E, Zeiler, F, Ercole, A, Placek, M, Tas, J, Donnelly, J, Aries, M, Hutchinson, P, Menon, D, Stocchetti, N, Czosnyka, M, Smielewski, P, Citerio, G, and Apollo - University of Cambridge Repository
Subjects: Cerebral autoregulation, Logistic Models, Traumatic brain injury, Intracranial Pressure, Cerebrovascular Circulation, Area Under Curve, Individualised cerebral perfusion pressure, Brain Injuries, Traumatic, Humans, Lower limit of reactivity, Retrospective Studies
Abstract: Background: A previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort. Methods: Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal–Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong’s test. Results: Average LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP. Conclusions: Using a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.
Published: 2023

34. Evaluation of the relationship between slow-waves of intracranial pressure, mean arterial pressure and brain tissue oxygen in TBI: a CENTER-TBI exploratory analysis

Author: Zeiler, Frederick A., Cabeleira, Manuel, Bellander, Bo-Michael, Beqiri, Erta, Buki, Andras, Carbonara, Marco, Chieregato, Arturo, Citerio, Giuseppe, Clusmann, Hans, Czeiter, Endre, Czosnyka, Marek, Hutchinson, Peter J., Depreitere, Bart, Ercole, Ari, Frisvold, Shirin, Helbok, Raimund, Jankowski, Stefan, Kondziella, Danile, Koskinen, Lars-Owe, Kowark, Ana, Menon, David K., Meyfroidt, Geert, Stocchetti, Nino, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Rocka, Saulius, Rossaint, Rolf, Sahuquillo, Juan, Sakowitz, Oliver, Smielewski, Peter, Sundström, Nina, Takala, Riikka, Tamosuitis, Tomas, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Vilcinis, Rimantas, Wolf, Stefan, Younsi, Alexander, CENTER-TBI High-Resolution ICU (HR ICU) Sub-Study Participants and Investigators, Audny, Anke, Beer, Ronny, Ragauskas, Arminas, Rocka, Saulius, Tamosuitis, Tomas, Vilcinis, Rimantas, „Springer' grupė, Ročka, Saulius, Tamošuitis, Tomas, Zeiler, Frederick A. [0000-0003-1737-0510], Stocchetti, Nino [0000-0003-3250-6834], Apollo - University of Cambridge Repository, Zeiler, F, Cabeleira, M, Hutchinson, P, Stocchetti, N, Czosnyka, M, Smielewski, P, Ercole, A, Anke, A, Beer, R, Bellander, B, Beqiri, E, Buki, A, Carbonara, M, Chieregato, A, Citerio, G, Clusmann, H, Czeiter, E, Depreitere, B, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Kowark, A, Menon, D, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, HUS Neurocenter, Clinicum, Helsinki University Hospital Area, and Neurokirurgian yksikkö
Subjects: Intracranial Pressure, Neurologi, CEREBRAL AUTOREGULATION, FLOW, Critical Care and Intensive Care Medicine, 3124 Neurology and psychiatry, CONSENSUS CONFERENCE, LOWER LIMIT, 0302 clinical medicine, Traumatic brain injury, Anesthesiology, Brain Injuries, Traumatic, TBI, Autoregulation, Cerebrovascular reactivity, Autoregressive integrated moving average, PART II, Intracranial pressure, Original Research, traumatic brain injury, autoregulation, Brain, Autoregressive model, Neurology, Cerebrovascular Circulation, Cardiology, brain tissue oxygen, cerebrovascular reactivity, Life Sciences & Biomedicine, medicine.medical_specialty, Mean arterial pressure, Brain tissue oxygen, INDEXES, Health Informatics, Cerebral autoregulation, CLASSIFICATION, 03 medical and health sciences, Internal medicine, medicine, INJURY, MANAGEMENT, Humans, Arterial Pressure, Science & Technology, business.industry, 3112 Neurosciences, 030208 emergency & critical care medicine, medicine.disease, nervous system diseases, Oxygen, Anesthesiology and Pain Medicine, Blood pressure, business, 030217 neurology & neurosurgery
Abstract: Journal of clinical monitoring and computing 35(4), 711-722 (2021). doi:10.1007/s10877-020-00527-6, Published by Springer Science + Business Media B.V., Dordrecht [u.a.]
Published: 2021

35. Modeling Brain-Heart Crosstalk Information in Patients with Traumatic Brain Injury

Author: Peter Smielewski, Erta Beqiri, Ari Ercole, Giovanna Maria Dimitri, Pietro Liò, Michał M. Placek, Nino Stocchetti, Marek Czosnyka, HUS Neurocenter, Clinicum, Helsinki University Hospital Area, Neurokirurgian yksikkö, Ragauskas, Arminas, Rocka, Saulius, Tamosuitis, Tomas, Vilcinis, Rimantas, „Springer' grupė, Dimitri, G, Beqiri, E, Placek, M, Czosnyka, M, Stocchetti, N, Ercole, A, Smielewski, P, Lió, P, Citerio, G, Ročka, Saulius, Tamošuitis, Tomas, Dimitri, Giovanna Maria [0000-0002-2728-4272], Lio, Pietro [0000-0002-0540-5053], and Apollo - University of Cambridge Repository
Subjects: Adult, medicine.medical_specialty, Adolescent, Intracranial Pressure, Traumatic brain injury, Intracranial pressure, CENTER-TBI, Critical Care and Intensive Care Medicine, Logistic regression, Standard deviation, 3124 Neurology and psychiatry, Cohort Studies, Young Adult, Heart Rate, Internal medicine, Heart rate, REGRESSION, Brain Injuries, Traumatic, medicine, MANAGEMENT, Humans, Raised heart rate, CENTER-TBI Collaborators, Aged, Monitoring, Physiologic, Aged, 80 and over, business.industry, Confounding, 3112 Neurosciences, Raised intracranial pressure, Brain, Heart, CARE, Middle Aged, medicine.disease, Point-biserial correlation coefficient, Cohort, Cardiology, Neurology (clinical), business
Abstract: Funder: Università degli Studi di Siena, BACKGROUND: Traumatic brain injury (TBI) is an extremely heterogeneous and complex pathology that requires the integration of different physiological measurements for the optimal understanding and clinical management of patients. Information derived from intracranial pressure (ICP) monitoring can be coupled with information obtained from heart rate (HR) monitoring to assess the interplay between brain and heart. The goal of our study is to investigate events of simultaneous increases in HR and ICP and their relationship with patient mortality.. METHODS: In our previous work, we introduced a novel measure of brain-heart interaction termed brain-heart crosstalks (ctnp), as well as two additional brain-heart crosstalks indicators [mutual information ([Formula: see text]) and average edge overlap (ωct)] obtained through a complex network modeling of the brain-heart system. These measures are based on identification of simultaneous increase of HR and ICP. In this article, we investigated the relationship of these novel indicators with respect to mortality in a multicenter TBI cohort, as part of the Collaborative European Neurotrauma Effectiveness Research in TBI high-resolution work package. RESULTS: A total of 226 patients with TBI were included in this cohort. The data set included monitored parameters (ICP and HR), as well as laboratory, demographics, and clinical information. The number of detected brain-heart crosstalks varied (mean 58, standard deviation 57). The Kruskal-Wallis test comparing brain-heart crosstalks measures of survivors and nonsurvivors showed statistically significant differences between the two distributions (p values: 0.02 for [Formula: see text], 0.005 for ctnp and 0.006 for ωct). An inverse correlation was found, computed using the point biserial correlation technique, between the three new measures and mortality: - 0.13 for ctnp (p value 0.04), - 0.19 for ωct (p value 0.002969) and - 0.09 for [Formula: see text] (p value 0.1396). The measures were then introduced into the logistic regression framework, along with a set of input predictors made of clinical, demographic, computed tomography (CT), and lab variables. The prediction models were obtained by dividing the original cohort into four age groups (16-29, 30-49, 50-65, and 65-85 years of age) to properly treat with the age confounding factor. The best performing models were for age groups 16-29, 50-65, and 65-85, with the deviance of ratio explaining more than 80% in all the three cases. The presence of an inverse relationship between brain-heart crosstalks and mortality was also confirmed. CONCLUSIONS: The presence of a negative relationship between mortality and brain-heart crosstalks indicators suggests that a healthy brain-cardiovascular interaction plays a role in TBI.
Published: 2020

36. Low-resolution pressure reactivity index and its derived optimal cerebral perfusion pressure in adult traumatic brain injury: a CENTER-TBI study

Author: Riemann, Lennart, Beqiri, Erta, Smielewski, Peter, Czosnyka, Marek, Stocchetti, Nino, Sakowitz, Oliver, Zweckberger, Klaus, Unterberg, Andreas, Younsi, Alexander, Anke, Audny, Beer, Ronny, Bellander, Bo-Michael, Buki, Andras, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Czeiter, Endre, Depreitere, Bart, Eapen, George, Frisvold, Shirin, Helbok, Raimund, Jankowski, Stefan, Kondziella, Daniel, Koskinen, Lars-Owe, Meyfroidt, Geert, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Rocka, Saulius, Rossaint, Rolf, Sahuquillo, Juan, Stevanovic, Ana, Sundström, Nina, Takala, Riikka, Tamosuitis, Tomas, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Vilcinis, Rimantas, Wolf, Stefan, Younsi, Alexander [0000-0002-8218-9243], Apollo - University of Cambridge Repository, Ragauskas, Arminas, Rocka, Saulius, Tamosuitis, Tomas, Vilcinis, Rimantas, „Springer' grupė, Ročka, Saulius, Tamošuitis, Tomas, Riemann, L, Beqiri, E, Smielewski, P, Czosnyka, M, Stocchetti, N, Sakowitz, O, Zweckberger, K, Unterberg, A, Younsi, A, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, and Wolf, S
Subjects: Adult, Male, medicine.medical_specialty, Multivariate statistics, Multivariate analysis, Neurologi, INTRACRANIAL-PRESSURE, Traumatic brain injury, Critical Care and Intensive Care Medicine, Cerebral autoregulation, 03 medical and health sciences, 0302 clinical medicine, Critical Care Medicine, General & Internal Medicine, Internal medicine, Brain Injuries, Traumatic, MANAGEMENT, medicine, Humans, Cerebrovascular reactivity, 030212 general & internal medicine, Cerebral perfusion pressure, Aged, Retrospective Studies, Intracranial pressure, CPPopt, Science & Technology, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Univariate, lcsh:RC86-88.9, Middle Aged, medicine.disease, Intensive Care Units, Blood pressure, Neurology, Cerebrovascular Circulation, Cardiology, Female, business, Life Sciences & Biomedicine, 030217 neurology & neurosurgery
Abstract: Background After traumatic brain injury (TBI), brain tissue can be further damaged when cerebral autoregulation is impaired. Managing cerebral perfusion pressure (CPP) according to computed “optimal CPP” values based on cerebrovascular reactivity indices might contribute to preventing such secondary injuries. In this study, we examined the discriminative value of a low-resolution long pressure reactivity index (LPRx) and its derived “optimal CPP” in comparison to the well-established high-resolution pressure reactivity index (PRx). Methods Using the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study dataset, the association of LPRx (correlation between 1-min averages of intracranial pressure and arterial blood pressure over a moving time frame of 20 min) and PRx (correlation between 10-s averages of intracranial pressure and arterial blood pressure over a moving time frame of 5 min) to outcome was assessed and compared using univariate and multivariate regression analysis. “Optimal CPP” values were calculated using a multi-window algorithm that was based on either LPRx or PRx, and their discriminative ability was compared. Results LPRx and PRx were both significant predictors of mortality in univariate and multivariate regression analysis, but PRx displayed a higher discriminative ability. Similarly, deviations of actual CPP from “optimal CPP” values calculated from each index were significantly associated with outcome in univariate and multivariate analysis. “Optimal CPP” based on PRx, however, trended towards more precise predictions. Conclusions LPRx and its derived “optimal CPP” which are based on low-resolution data were significantly associated with outcome after TBI. However, they did not reach the discriminative ability of the high-resolution PRx and its derived “optimal CPP.” Nevertheless, LPRx might still be an interesting tool to assess cerebrovascular reactivity in centers without high-resolution signal monitoring. Trial registration ClinicalTrials.gov Identifier: NCT02210221. First submitted July 29, 2014. First posted August 6, 2014.
Published: 2020
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37. Quality indicators for patients with traumatic brain injury in European intensive care units: A CENTER-TBI study

Author: Huijben, Jilske A., Wiegers, Eveline J. A., Ercole, Ari, De Keizer, Nicolette F., Maas, Andrew I. R., Steyerberg, Ewout W., Citerio, Giuseppe, Wilson, Lindsay, Polinder, Suzanne, Nieboer, Daan, Menon, David, Lingsma, Hester F., Van Der Jagt, Mathieu, Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Beer, Ronny, Bellander, Bo-Michael, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Beqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Brorsson, Camilla, Buki, Andras, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Carbonara, Marco, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, De Keyser, Véronique, Degos, Vincent, Corte, Francesco Della, Den Boogert, Hugo, Depreitere, Bart, Dilvesi, Dula, Dixit, Abhishek, Dreier, Jens, Dulière, Guy-Loup, Ezer, Erzsébet, Fabricius, Martin, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Galanaud, Damien, Gantner, Dashiell, Ghuysen, Alexandre, Giga, Lelde, Golubovic, Jagos, Gomez, Pedro A., Grossi, Francesca, Gupta, Deepak, Haitsma, Iain, Helbok, Raimund, Helseth, Eirik, Hutchinson, Peter J., Jankowski, Stefan, Johnson, Faye, Karan, Mladen, Kolias, Angelos G., Kondziella, Daniel, Koraropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Laureys, Steven, Lecky, Fiona, Ledoux, Didier, Lejeune, Aurelie, Lightfoot, Roger, Manara, Alex, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Menovsky, Tomas, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Nelson, David, Newcombe, Virginia, Nyirádi, József, Ortolano, Fabrizio, Payen, Jean-François, Perlbarg, Vincent, Persona, Paolo, Peul, Wilco, Piippo-Karjalainen, Anna, Ples, Horia, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Richter, Sophie, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Sahuquillo, Juan, Sandrød, Oddrun, Sakowitz, Oliver, Sanchez-Porras, Renan, Schirmer-Mikalsen, Kari, Schou, Rico Frederik, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Stocchetti, Nino, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Tenovuo, Olli, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Trapani, Tony, Tudora, Cristina Maria, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Van Der Steen, Gregory, Van Dijck, Jeroen T. J. M., Van Essen, Thomas A., Van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Vik, Anne, Vilcinis, Rimantas, Volovici, Victor, Voormolen, Daphne, Vulekovic, Petar, Williams, Guy, Winzeck, Stefan, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Ziverte, Agate, Zoerle, Tommaso, Clusmann, Hans, Huijben, J. A., Wiegers, E. J. A., Ercole, A., De Keizer, N. F., Maas, A. I. R., Steyerberg, E. W., Citerio, G., Wilson, L., Polinder, S., Nieboer, D., Menon, D., Lingsma, H. F., Van Der Jagt, M., Akerlund, C., Amrein, K., Andelic, N., Andreassen, L., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Beer, R., Bellander, B. -M., Benali, H., Berardino, M., Beretta, L., Beqiri, E., Blaabjerg, M., Lund, S. B., Brorsson, C., Buki, A., Cabeleira, M., Caccioppola, A., Calappi, E., Calvi, M. R., Cameron, P., Lozano, G. C., Carbonara, M., Castano-Leon, A. M., Cavallo, S., Chevallard, G., Chieregato, A., Coburn, M., Coles, J., Cooper, J. D., Correia, M., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Dark, P., De Keyser, V., Degos, V., Corte, F. D., Den Boogert, H., Depreitere, B., Dilvesi, D., Dixit, A., Dreier, J., Duliere, G. -L., Ezer, E., Fabricius, M., Foks, K., Frisvold, S., Furmanov, A., Galanaud, D., Gantner, D., Ghuysen, A., Giga, L., Golubovic, J., Gomez, P. A., Grossi, F., Gupta, D., Haitsma, I., Helbok, R., Helseth, E., Hutchinson, P. J., Jankowski, S., Johnson, F., Karan, M., Kolias, A. G., Kondziella, D., Koraropoulos, E., Koskinen, L. -O., Kovacs, N., Kowark, A., Lagares, A., Laureys, S., Lecky, F., Ledoux, D., Lejeune, A., Lightfoot, R., Manara, A., Martino, C., Marechal, H., Mattern, J., Mcmahon, C., Menovsky, T., Misset, B., Muraleedharan, V., Murray, L., Negru, A., Nelson, D., Newcombe, V., Nyiradi, J., Ortolano, F., Payen, J. -F., Perlbarg, V., Persona, P., Peul, W., Piippo-Karjalainen, A., Ples, H., Pomposo, I., Posti, J. P., Puybasset, L., Radoi, A., Ragauskas, A., Raj, R., Rhodes, J., Richter, S., Rocka, S., Roe, C., Roise, O., Rosenfeld, J. V., Rosenlund, C., Rosenthal, G., Rossaint, R., Rossi, S., Sahuquillo, J., Sandrod, O., Sakowitz, O., Sanchez-Porras, R., Schirmer-Mikalsen, K., Schou, R. F., Smielewski, P., Sorinola, A., Stamatakis, E., Stocchetti, N., Sundstrom, N., Takala, R., Tamas, V., Tamosuitis, T., Tenovuo, O., Thomas, M., Tibboel, D., Tolias, C., Trapani, T., Tudora, C. M., Vajkoczy, P., Vallance, S., Valeinis, E., Vamos, Z., Van Der Steen, G., Van Dijck, J. T. J. M., Van Essen, T. A., Van Wijk, R. P. J., Vargiolu, A., Vega, E., Vik, A., Vilcinis, R., Volovici, V., Voormolen, D., Vulekovic, P., Williams, G., Winzeck, S., Wolf, S., Younsi, A., Zeiler, F. A., Ziverte, A., Zoerle, T., Clusmann, H., Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Public Health, Neurosurgery, Intensive Care, Huijben, J, Wiegers, E, Ercole, A, de Keizer, N, Maas, A, Steyerberg, E, Citerio, G, Wilson, L, Polinder, S, Nieboer, D, Menon, D, Lingsma, H, van der Jagt, M, Huijben, Jilske A. [0000-0002-2892-5406], Citerio, Giuseppe [0000-0002-5374-3161], Apollo - University of Cambridge Repository, Huijben, Jilske A [0000-0002-2892-5406], Ercole, Ari [0000-0001-8350-8093], Medical Informatics, APH - Methodology, APH - Quality of Care, and APH - Digital Health
Subjects: Adult, Male, benchmarking, intensive care units, quality indicators, quality of health care, traumatic brain injuries, medicine.medical_specialty, Quality management, Traumatic brain injury, Quality indicator, Quality indicators, Critical Care and Intensive Care Medicine, Traumatic brain injuries, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Brain Injuries, Traumatic, medicine, Humans, Intensive care unit, 030212 general & internal medicine, Quality Indicators, Health Care, Intensive care units, business.industry, Data Collection, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Quality measurement, Regression analysis, lcsh:RC86-88.9, Odds ratio, Middle Aged, medicine.disease, Random effects model, Quality Improvement, Europe, Benchmarking, Emergency medicine, Quality of health care, Female, Human medicine, business, 030217 neurology & neurosurgery
Abstract: Background The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Methods Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10. Results A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p Conclusions Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators. Trial registration The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
Published: 2020

38. Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

Author: Huijben, Jilske A., Wiegers, Eveline J. A., Lingsma, Hester F., Citerio, Giuseppe, Maas, Andrew I. R., Menon, David K., Ercole, Ari, Nelson, David, van der Jagt, Mathieu, Steyerberg, Ewout W., Helbok, Raimund, Lecky, Fiona, Peul, Wilco, Birg, Tatiana, Zoerle, Tommaso, Carbonara, Marco, Stocchetti, Nino, Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Beer, Ronny, Bellander, Bo-Michael, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Beqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Brorsson, Camilla, Buki, Andras, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, DeKeyser, Véronique, Degos, Vincent, Della Corte, Francesco, den Boogert, Hugo, Depreitere, Bart, Dilvesi, Dula, Dixit, Abhishek, Dreier, Jens, Dulière, Guy-Loup, Ezer, Erzsébet, Fabricius, Martin, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Galanaud, Damien, Gantner, Dashiell, Ghuysen, Alexandre, Giga, Lelde, Golubovic, Jagos, Gomez, Pedro A., Grossi, Francesca, Gupta, Deepak, Haitsma, Iain, Helseth, Eirik, Hutchinson, Peter J., Jankowski, Stefan, Johnson, Faye, Karan, Mladen, Kolias, AngelosG., Kondziella, Daniel, Koraropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Laureys, Steven, Ledoux, Didier, Lejeune, Aurelie, Lightfoot, Roger, Manara, Alex, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Menovsky, Tomas, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Newcombe, Virginia, Nyirádi, József, Ortolano, Fabrizio, Payen, Jean-François, Perlbarg, Vincent, Persona, Paolo, Piippo-Karjalainen, Anna, Ples, Horia, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Richter, Sophie, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Sahuquillo, Juan, Sandrød, Oddrun, Sakowitz, Oliver, Sanchez-Porras, Renan, Schirmer-Mikalsen, Kari, Schou, Rico Frederik, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Tenovuo, Olli, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Trapani, Tony, Tudora, CristinaMaria, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Van der Steen, Gregory, van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Vik, Anne, Vilcinis, Rimantas, Volovici, Victor, Vulekovic, Petar, Williams, Guy, Winzeck, Stefan, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Clusmann, Agate Ziverte Hans, Voormolen, Daphne, van Dijck, Jeroen T. J. M., van Essen, Thomas A., Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Tamosuitis, Tomas, „Springer' grupė, CTR-TBI Investigators Participants, Huijben, J, Wiegers, E, Lingsma, H, Citerio, G, Maas, A, Menon, D, Ercole, A, Nelson, D, van der Jagt, M, Steyerberg, E, Helbok, R, Lecky, F, Peul, W, Birg, T, Zoerle, T, Carbonara, M, Stocchetti, N, Huijben, Jilske A. [0000-0002-2892-5406], Apollo - University of Cambridge Repository, Huijben, Jilske A [0000-0002-2892-5406], Huijben, J. A., Wiegers, E. J. A., Lingsma, H. F., Citerio, G., Maas, A. I. R., Menon, D. K., Ercole, A., Nelson, D., van der Jagt, M., Steyerberg, E. W., Helbok, R., Lecky, F., Peul, W., Birg, T., Zoerle, T., Carbonara, M., Stocchetti, N., Akerlund, C., Amrein, K., Andelic, N., Andreassen, L., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Beer, R., Bellander, B. -M., Benali, H., Berardino, M., Beretta, L., Beqiri, E., Blaabjerg, M., Lund, S. B., Brorsson, C., Buki, A., Cabeleira, M., Caccioppola, A., Calappi, E., Calvi, M. R., Cameron, P., Lozano, G. C., Castano-Leon, A. M., Cavallo, S., Chevallard, G., Chieregato, A., Coburn, M., Coles, J., Cooper, J. D., Correia, M., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Dark, P., Dekeyser, V., Degos, V., Della Corte, F., den Boogert, H., Depreitere, B., Dilvesi, D., Dixit, A., Dreier, J., Duliere, G. -L., Ezer, E., Fabricius, M., Foks, K., Frisvold, S., Furmanov, A., Galanaud, D., Gantner, D., Ghuysen, A., Giga, L., Golubovic, J., Gomez, P. A., Grossi, F., Gupta, D., Haitsma, I., Helseth, E., Hutchinson, P. J., Jankowski, S., Johnson, F., Karan, M., Kolias, A. G., Kondziella, D., Koraropoulos, E., Koskinen, L. -O., Kovacs, N., Kowark, A., Lagares, A., Laureys, S., Ledoux, D., Lejeune, A., Lightfoot, R., Manara, A., Martino, C., Marechal, H., Mattern, J., Mcmahon, C., Menovsky, T., Misset, B., Muraleedharan, V., Murray, L., Negru, A., Newcombe, V., Nyiradi, J., Ortolano, F., Payen, J. -F., Perlbarg, V., Persona, P., Piippo-Karjalainen, A., Ples, H., Pomposo, I., Posti, J. P., Puybasset, L., Radoi, A., Ragauskas, A., Raj, R., Rhodes, J., Richter, S., Rocka, S., Roe, C., Roise, O., Rosenfeld, J. V., Rosenlund, C., Rosenthal, G., Rossaint, R., Rossi, S., Sahuquillo, J., Sandrod, O., Sakowitz, O., Sanchez-Porras, R., Schirmer-Mikalsen, K., Schou, R. F., Smielewski, P., Sorinola, A., Stamatakis, E., Sundstrom, N., Takala, R., Tamas, V., Tamosuitis, T., Tenovuo, O., Thomas, M., Tibboel, D., Tolias, C., Trapani, T., Tudora, C. M., Vajkoczy, P., Vallance, S., Valeinis, E., Vamos, Z., Van der Steen, G., van Wijk, R. P. J., Vargiolu, A., Vega, E., Vik, A., Vilcinis, R., Volovici, V., Vulekovic, P., Williams, G., Winzeck, S., Wolf, S., Younsi, A., Zeiler, F. A., Clusmann, A. Z. H., Voormolen, D., van Dijck, J. T. J. M., van Essen, T. A., Public Health, and Intensive Care
Subjects: medicine.medical_specialty, Critical Care, Neurologi, Traumatic brain injury, Original, Intracranial pressure, Population, Critical Care and Intensive Care Medicine, Intensive care unit, Traumatic brain injury, Intracranial pressure, Outcome, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Anesthesiology, Brain Injuries, Traumatic, Medicine, Humans, Glasgow Coma Scale, Intensive care unit, Israel, education, Outcome, education.field_of_study, business.industry, 030208 emergency & critical care medicine, Odds ratio, Middle Aged, medicine.disease, 3. Good health, Europe, Intensive Care Units, 030228 respiratory system, Neurology, Emergency medicine, Human medicine, business
Abstract: Purpose: To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. Methods: This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. Results: A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13–15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p
Published: 2020

39. Diffuse Intracranial Injury Patterns Are Associated with Impaired Cerebrovascular Reactivity in Adult Traumatic Brain Injury: A CENTER-TBI Validation Study

Author: Frederick A. Zeiler, François Mathieu, Miguel Monteiro, Ben Glocker, Ari Ercole, Erta Beqiri, Manuel Cabeleira, Nino Stocchetti, Peter Smielewski, Marek Czosnyka, Virginia Newcombe, David K. Menon, Audny Anke, Bo-Michael Bellander, Andras Buki, Marco Carbonara, Arturo Chieregato, Giuseppe Citerio, Hans Clusmann, Endre Czeiter, Bart Depreitere, Shirin Frisvold, Raimund Helbok, Stefan Jankowski, Danile Kondziella, Lars-Owe Koskinen, Ana Kowark, Geert Meyfroidt, Kirsten Moeller, David Nelson, Anna Piippo-Karjalainen, Andreea Radoi, Arminas Ragauskas, Rahul Raj, Jonathan Rhodes, Saulius Rocka, Rolf Rossaint, Juan Sahuquillo, Oliver Sakowitz, Nina Sundström, Riikka Takala, Tomas Tamosuitis, Olli Tenovuo, Peter Vajkoczy, Alessia Vargiolu, Rimantas Vilcinis, Stefan Wolf, Alexander Younsi, Zeiler, F, Mathieu, F, Monteiro, M, Glocker, B, Ercole, A, Beqiri, E, Cabeleira, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Newcombe, V, Menon, D, and Citerio, G
Subjects: Adult, Male, 030506 rehabilitation, medicine.medical_specialty, Validation study, Traumatic brain injury, injury pattern, Computed tomography, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cerebrovascular reactivity, Brain Injuries, Traumatic, medicine, Retrospective analysis, Humans, Autoregulation, Prospective Studies, image segmentation, medicine.diagnostic_test, business.industry, autoregulation, computed tomography, PRx, Original Articles, Middle Aged, medicine.disease, humanities, Cerebrovascular Circulation, Female, Neurology (clinical), Radiology, 0305 other medical science, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, CT
Abstract: Recent single-center retrospective analysis displayed the association between admission computed tomography (CT) markers of diffuse intracranial injury and worse cerebrovascular reactivity. The goal of this study was to further explore these associations using the prospective multi-center Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) high-resolution intensive care unit (HR ICU) data set. Using the CENTER-TBI HR ICU sub-study cohort, we evaluated those patients with both archived high-frequency digital physiology (100 Hz or higher) and the presence of a digital admission CT scan. Physiological signals were processed for pressure reactivity index (PRx) and both the percent (%) time above defined PRx thresholds and mean hourly dose above threshold. Admission CT injury scores were obtained from the database. Quantitative contusion, edema, intraventricular hemorrhage (IVH), and extra-axial lesion volumes were obtained via semi-automated segmentation. Comparison between admission CT characteristics and PRx metrics was conducted using Mann-U, Jonckheere-Terpstra testing, with a combination of univariate linear and logistic regression techniques. A total of 165 patients were included. Cisternal compression and high admission Rotterdam and Helsinki CT scores, and Marshall CT diffuse injury sub-scores were associated with increased percent (%) time and hourly dose above PRx threshold of 0, +0.25, and +0.35 (p
Published: 2020

40. Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury : a CENTER-TBI analysis

Author: Zeiler, Frederick A., Ercole, Ari, Beqiri, Erta, Cabeleira, Manuel, Aries, Marcel, Zoerle, Tommaso, Carbonara, Marco, Stocchetti, Nino, Smielewski, Peter, Czosnyka, Marek, CENTER-TBI High Resolution ICU (HR ICU) Sub-Study Participants And Investigators, Menon, David K., Anke, Audny, Beer, Ronny, Bellander, Bo-Michael, Buki, Andras, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Czeiter, Endre, Depreitere, Bart, Eapen, George, Frisvold, Shirin, Helbok, Raimund, Jankowski, Stefan, Kondziella, Daniel, Koskinen, Lars-Owe, Meyfroidt, Geert, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Rocka, Saulius, Rossaint, Rolf, Sahuquillo, Juan, Sakowitz, Oliver, Stevanovic, Ana, Sundström, Nina, Takala, Riikka, Tamosuitis, Tomas, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Vilcinis, Rimantas, Wolf, Stefan, Younsi, Alexander, HUS Neurocenter, Department of Neurosciences, Neurokirurgian yksikkö, Staff Services, Helsinki University Hospital Area, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Zeiler, Frederick A. [0000-0003-1737-0510], Apollo - University of Cambridge Repository, Zeiler, F, Ercole, A, Beqiri, E, Cabeleira, M, Aries, M, Zoerle, T, Carbonara, M, Stocchetti, N, Smielewski, P, Czosnyka, M, Menon, D, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Intensive Care, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, and MUMC+: MA Medische Staf IC (9)
Subjects: Male, Neurology, Neurologi, cerebrovascular reactivity, PRx, TBI, therapeutic intensity, TIL, 3124 Neurology and psychiatry, 030218 nuclear medicine & medical imaging, Cohort Studies, 0302 clinical medicine, Brain Injuries, Traumatic, Cerebrovascular reactivity, Young adult, Neuroradiology, Therapeutic intensity, Middle Aged, AUTOREGULATION, ISOFLURANE, Treatment Outcome, CEREBRAL PERFUSION-PRESSURE, Cerebrovascular Circulation, Cardiology, Female, Neurosurgery, Life Sciences & Biomedicine, Cohort study, Adult, medicine.medical_specialty, Critical Care, Traumatic brain injury, Clinical Neurology, Cerebrovascular reactivity, PRx, TBI, Therapeutic intensity, TIL, Young Adult, 03 medical and health sciences, Original Article - Brain trauma, Brain trauma, Internal medicine, medicine, MANAGEMENT, Humans, Arterial Pressure, ddc:610, Aged, Retrospective Studies, SUPPRESSION, Science & Technology, business.industry, 3112 Neurosciences, Retrospective cohort study, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Blood pressure, MODERATE HYPOTHERMIA, Surgery, Neurology (clinical), Neurosciences & Neurology, Intracranial Hypertension, business, 030217 neurology & neurosurgery
Abstract: Acta neurochirurgica 161(9), 1955-1964 (2019). doi:10.1007/s00701-019-03980-8, Published by Springer, Wien [u.a.]
Published: 2019

41. Compensatory-reserve-weighted intracranial pressure versus intracranial pressure for outcome association in adult traumatic brain injury : a CENTER-TBI validation study

Author: Zeiler, Frederick A., Ercole, Ari, Cabeleira, Manuel, Beqiri, Erta, Zoerle, Tommaso, Carbonara, Marco, Stocchetti, Nino, Menon, David K., Smielewski, Peter, Czosnyka, Marek, Anke, Audny, Beer, Ronny, Bellander, Bo-Michael, Buki, Andras, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Czeiter, Endre, Depreitere, Bart, Eapen, George, Frisvold, Shirin, Helbok, Raimund, Jankowski, Stefan, Kondziella, Daniel, Koskinen, Lars-Owe, Meyfroidt, Geert, Moeller, Kirsten, Nelson, David, Piippo-Karjalainen, Anna, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Rocka, Saulius, Rossaint, Rolf, Sahuquillo, Juan, Sakowitz, Oliver, Stevanovic, Ana, Sundström, Nina, Takala, Riikka, Tamosuitis, Tomas, Tenovuo, Olli, Vajkoczy, Peter, Vargiolu, Alessia, Vilcinis, Rimantas, Wolf, Stefan, Younsi, Alexander, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Zeiler, F, Ercole, A, Cabeleira, M, Beqiri, E, Zoerle, T, Carbonara, M, Stocchetti, N, Menon, D, Smielewski, P, Czosnyka, M, Anke, A, Beer, R, Bellander, B, Buki, A, Chevallard, G, Chieregato, A, Citerio, G, Czeiter, E, Depreitere, B, Eapen, G, Frisvold, S, Helbok, R, Jankowski, S, Kondziella, D, Koskinen, L, Meyfroidt, G, Moeller, K, Nelson, D, Piippo-Karjalainen, A, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Rocka, S, Rossaint, R, Sahuquillo, J, Sakowitz, O, Stevanovic, A, Sundstrom, N, Takala, R, Tamosuitis, T, Tenovuo, O, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Younsi, A, Neurokirurgian yksikkö, Helsinki University Hospital Area, HUS Neurocenter, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Zeiler, Frederick A. [0000-0003-1737-0510], and Apollo - University of Cambridge Repository
Subjects: Male, Neurologi, Logistic regression, 3124 Neurology and psychiatry, 030218 nuclear medicine & medical imaging, law.invention, 0302 clinical medicine, law, Brain Injuries, Traumatic, Weighted ICP, Intracranial pressure, Outcome, Univariate analysis, Area under the curve, Middle Aged, Intensive care unit, Intensive Care Units, compensatory reserve, intracranial pressure, outcome, weighted ICP, Neurology, Cohort, Cardiology, Female, Intracranial Pressure/physiology, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Compensatory reserve, Intracranial pressure, Outcome, Weighted ICP, Traumatic brain injury, Clinical Neurology, 03 medical and health sciences, Brain trauma, Original Article - Brain trauma, Internal medicine, medicine, MANAGEMENT, Humans, ddc:610, Aged, Retrospective Studies, Brain Injuries, Traumatic/physiopathology, Science & Technology, business.industry, Univariate, 3112 Neurosciences, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Compensatory reserve, nervous system diseases, Surgery, Neurology (clinical), Neurosciences & Neurology, business, 030217 neurology & neurosurgery
Abstract: Background Compensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6 months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort. Methods Using the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived ICP and wICP (calculated as wICP = (1 − RAP) × ICP; where RAP is the compensatory reserve index derived from the moving correlation between pulse amplitude of ICP and ICP). Various univariate logistic regression models were created comparing ICP and wICP to dichotomized outcome at 6 to 12 months, based on Glasgow Outcome Score—Extended (GOSE) (alive/dead—GOSE ≥ 2/GOSE = 1; favorable/unfavorable—GOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values. Results wICP displayed higher AUC compared to ICP on univariate regression for alive/dead outcome compared to mean ICP (AUC 0.712, 95% CI 0.615–0.810, p = 0.0002, and AUC 0.642, 95% CI 0.538–746, p
Published: 2019

42. Feasibility and Safety of Integrating Extended TCD Assessments in a Full Multimodal Neuromonitoring Protocol After Traumatic Brain Injury.

Author: Bögli SY, Cucciolini G, Cherchi MS, Motroni V, Olakorede I, O'Leary R, Beqiri E, Smith CA, and Smielewski P
Subjects: Humans, Male, Female, Adult, Middle Aged, Cerebrovascular Circulation, Monitoring, Physiologic methods, Intracranial Pressure, Brain Injuries, Traumatic diagnostic imaging, Brain Injuries, Traumatic physiopathology, Ultrasonography, Doppler, Transcranial methods, Feasibility Studies
Abstract: Objective: Targeting single monitoring modalities such as intracranial pressure (ICP) or cerebral perfusion pressure alone has shown to be insufficient in improving outcome after traumatic brain injury (TBI). Multimodality monitoring (MMM) allows for a more complete description of brain function and for individualized management. Transcranial Doppler (TCD) represents the gold standard for continuous cerebral blood flow velocity assessment, but requires high levels skill and time. In TBI, the practical aspects of conducting extended TCD monitoring sessions have yet to be evaluated., Methods: Patients with acute moderate-to-severe TBI admitted to the neurocritical care unit between March 2022 and December 2023 receiving invasive ICP measurements were evaluated for inclusion. Exclusion criteria included trauma incompatible with TCD monitoring and if MMM was unwarranted. Daily MMM sessions (in addition to regular monitoring) were performed using TCD (Delica EMS 9D System or the DWL Doppler Box) for ≤5 d. Quantitative and qualitative feasibility, safety, and quality metrics were assessed., Results: Of 74 patients, 36 (75% male; mean age, 44 ± 17 y) were included. Common reasons for exclusion were skull fractures (n = 12) and decompressive craniectomy (n = 9). We acquired 88 recordings (mean, 275 ± 88 min). Overall monitoring times increased, and set-up times decreased. Physiologic variables (including ICP/brain temperature) did not change with TCD application. A single adverse event (dislodging of a microdialysis catheter) occurred., Conclusion: Implementing extended TCD monitoring in MMM protocols is feasible and safe. Considering these results, inclusion of long-term TCD as part of the MMM is strongly encouraged to allow for in-depth description and direct evaluation of hemodynamic changes after TBI., Competing Interests: Declaration of competing interest Peter Smielewski receives part of the licensing fees for ICM+ software, licensed by Cambridge Enterprise Ltd, University of Cambridge, Cambridge. The other authors declare no financial or non-financial conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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43. Cerebral autoregulation in pediatric and neonatal intensive care: A scoping review.

Author: Fedriga M, Martini S, Iodice FG, Sortica da Costa C, Pezzato S, Moscatelli A, Beqiri E, Czosnyka M, Smielewski P, and Agrawal S
Subjects: Humans, Infant, Newborn, Child, Infant, Intensive Care, Neonatal methods, Child, Preschool, Brain physiopathology, Homeostasis physiology, Cerebrovascular Circulation physiology
Abstract: Deranged cerebral autoregulation (CA) is associated with worse outcome in adult brain injury. Strategies for monitoring CA and maintaining the brain at its 'best CA status' have been implemented, however, this approach has not yet developed for the paediatric population. This scoping review aims to find up-to-date evidence on CA assessment in children and neonates with a view to identify patient categories in which CA has been measured so far, CA monitoring methods and its relationship with clinical outcome if any. A literature search was conducted for studies published within 31st December 2022 in 3 bibliographic databases. Out of 494 papers screened, this review includes 135 studies. Our literature search reveals evidence for CA measurement in the paediatric population across different diagnostic categories and age groups. The techniques adopted, indices and thresholds used to assess and define CA are heterogeneous. We discuss the relevance of available evidence for CA assessment in the paediatric population. However, due to small number of studies and heterogeneity of methods used, there is no conclusive evidence to support universal adoption of CA monitoring, technique, and methodology. This calls for further work to understand the clinical impact of CA monitoring in paediatric and neonatal intensive care., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Peter Smielewski and Marek Czosnyka receive part of the licensing fees for ICM+ software, licensed by Cambridge Enterprise Ltd, University of Cambridge, Cambridge.
Published: 2024
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44. Effect of Decompressive Craniectomy on Intracranial Pressure Waveforms and Vascular Reactivity: A Systematic Scoping Review.

Author: Rochat T, Bögli SY, Beqiri E, Quintard H, Czosnyka M, Hutchinson P, and Smielewski P
Abstract: Decompressive craniectomy (DC) primarily aims at decreasing intracranial pressure (ICP) by allowing for the brain tissue to expand. However, it is uncertain to what extent DC impacts the transmission of vasogenic slow waves and thus the validity and utility of the pressure reactivity index (PRx). The purpose of this systematically performed scoping review is to assess the current knowledge of the impact of DC on ICP waveforms and measures of vascular reactivity. This scoping review considered studies including patients over 18 years old suffering from acute brain injuries (ABIs), who underwent secondary DC and had a perioperative (pre/post-DC) recording of ICP or waveform analysis. A search was conducted in EMBASE, PubMed, Web of Science, Scopus, and Medline from November 2023 till January 2024, yielding 787 studies. Duplicated studies were automatically removed, and two researchers independently screened the remaining studies. After examining 586 titles and abstracts, 38 full-text studies were assessed for eligibility, and 4 studies were included in the final review. The review suggests that cerebrovascular reactivity and slow waves are altered after DC, with positive PRx values and reduced slow power. One study suggested that the nature of slow waves and interactions is on the whole largely preserved. However, the findings should be interpreted with caution due to methodological limitations and the low number of studies., (© The Author(s) 2024. Published by Mary Ann Liebert, Inc.)
Published: 2024
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45. CPPopt on Medical Devices: The Imitation Game.

Author: Beqiri E
Published: 2024
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46. Understanding the Brain-Heart-Lung Triangle: Mission Impossible?

Author: Sanfilippo F, Uryga A, Ball L, Battaglini D, Smielewski P, Beqiri E, Czosnyka M, and Robba C
Published: 2024
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47. Intracranial pressure monitoring in adult patients with traumatic brain injury: challenges and innovations.

Author: Zoerle T, Beqiri E, Åkerlund CAI, Gao G, Heldt T, Hawryluk GWJ, and Stocchetti N
Subjects: Humans, Monitoring, Physiologic methods, Adult, Neurophysiological Monitoring methods, Brain Injuries, Traumatic physiopathology, Brain Injuries, Traumatic diagnosis, Brain Injuries, Traumatic therapy, Intracranial Pressure physiology, Intracranial Hypertension diagnosis, Intracranial Hypertension physiopathology, Intracranial Hypertension etiology
Abstract: Intracranial pressure monitoring enables the detection and treatment of intracranial hypertension, a potentially lethal insult after traumatic brain injury. Despite its widespread use, robust evidence supporting intracranial pressure monitoring and treatment remains sparse. International studies have shown large variations between centres regarding the indications for intracranial pressure monitoring and treatment of intracranial hypertension. Experts have reviewed these two aspects and, by consensus, provided practical approaches for monitoring and treatment. Advances have occurred in methods for non-invasive estimation of intracranial pressure although, for now, a reliable way to non-invasively and continuously measure intracranial pressure remains aspirational. Analysis of the intracranial pressure signal can provide information on brain compliance (ie, the ability of the cranium to tolerate volume changes) and on cerebral autoregulation (ie, the ability of cerebral blood vessels to react to changes in blood pressure). The information derived from the intracranial pressure signal might allow for more individualised patient management. Machine learning and artificial intelligence approaches are being increasingly applied to intracranial pressure monitoring, but many obstacles need to be overcome before their use in clinical practice could be attempted. Robust clinical trials are needed to support indications for intracranial pressure monitoring and treatment. Progress in non-invasive assessment of intracranial pressure and in signal analysis (for targeted treatment) will also be crucial., Competing Interests: Declaration of interests EB reports scholarships from the Gates Cambridge Trust and the Medical Research Council (UK). GWJH reports grants from the Department of Defense (USA); is a board member of Global Neuro (Switzerland), a not-for profit provider of educational material on the topic of neurotrauma; and is medical director of the Brain Trauma Foundation (USA). TH reports patents (US patent number 8,366,627; PCT application number PCT/US2019/029776; and PCT/US2023/076170) that all resulted from academic work, are owned by the Massachusetts Institute of Technology, have not been licensed to any commercial entity, and no royalty or license fees have been obtained by MIT or the co-inventors. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)
Published: 2024
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48. Association between EEG metrics and continuous cerebrovascular autoregulation assessment: a scoping review.

Author: Bögli SY, Cherchi MS, Beqiri E, and Smielewski P
Subjects: Humans, Intracranial Pressure physiology, Animals, Ultrasonography, Doppler, Transcranial methods, Homeostasis physiology, Cerebrovascular Circulation physiology, Electroencephalography methods
Abstract: Objective: Cerebrovascular autoregulation is defined as the capacity of cerebral blood vessels to maintain stable cerebral blood flow despite changing blood pressure. It is assessed using the pressure reactivity index (the correlation coefficient between mean arterial blood pressure and intracranial pressure). The objective of this scoping review is to describe the existing evidence concerning the association of EEG and cerebrovascular autoregulation in order to identify key concepts and detect gaps in the current knowledge., Methods: Embase, MEDLINE, SCOPUS, and Web of Science were searched considering articles between their inception up to September 2023. Inclusion criteria were human (paediatric and adult) and animal studies describing correlations between continuous EEG and cerebrovascular autoregulation assessments., Results: Ten studies describing 481 human subjects (67% adult, 59% critically ill) were identified. Seven studies assessed qualitative (e.g. seizures, epileptiform potentials) and five evaluated quantitative (e.g. bispectral index, alpha-delta ratio) EEG metrics. Cerebrovascular autoregulation was evaluated based on intracranial pressure, transcranial Doppler, or near infrared spectroscopy. Specific combinations of cerebrovascular autoregulation and EEG metrics were evaluated by a maximum of two studies. Seizures, highly malignant patterns or burst suppression, alpha peak frequency, and bispectral index were associated with cerebrovascular autoregulation. The other metrics showed either no or inconsistent associations., Conclusion: There is a paucity of studies evaluating the link between EEG and cerebrovascular autoregulation. The studies identified included a variety of EEG and cerebrovascular autoregulation acquisition methods, age groups, and diseases allowing for few overarching conclusions. However, the preliminary evidence for the presence of an association between EEG metrics and cerebrovascular autoregulation prompts further in-depth investigations., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Published: 2024
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49. Multi-Modal Assessment of Cerebral Hemodynamics in Resuscitated Out-of-Hospital Cardiac Arrest Patients: A Case-Series.

Author: Lim SL, Myint MZ, Woo KL, Chee EYH, Hong CS, Beqiri E, Smielewski P, Ong MEH, and Sharma VK
Abstract: We assessed the feasibility of concurrent monitoring of cerebral hemodynamics in adult, comatose out-of-hospital cardiac arrest (OHCA) patients admitted to the National University Heart Centre Singapore from October 2021 to August 2023. Patients underwent continuous near-infrared spectroscopy (NIRS) monitoring in the first 72 h after return of spontaneous circulation (ROSC) and 30-min transcranial Doppler ultrasound (TCD) monitoring at least once. With constant mechanical ventilatory settings and continuous electrocardiographic, pulse oximeter and end-tidal carbon dioxide monitoring, blood pressure was manipulated via vasopressors and cerebral autoregulation assessed by measuring changes in regional cerebral oxygenation (NIRS) and cerebral blood flow velocities (TCD) in response to changes in mean arterial pressure. The primary outcome was neurological recovery at hospital discharge. Amongst the first 16 patients (median age 61, 94% males), we observed four unique patterns: preserved cerebral autoregulation, loss of cerebral autoregulation, cardio-cerebral asynchrony and cerebral circulatory arrest. Patients with preserved cerebral autoregulation had lower levels of neuro-injury biomarkers (neurofilaments light and heavy) and the majority (86%) were discharged with good neurological recovery. Multi-modal assessment of cerebral hemodynamics after OHCA is feasible and derived patterns correlated with neurological outcomes. The between- and within-patient heterogeneity in cerebral hemodynamics calls for more research on individualized treatment strategies.
Published: 2024
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50. Correction: Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Physiology and Big Data.

Author: Beqiri E, Badjatia N, Ercole A, Foreman B, Hu P, Hu X, LaRovere K, Meyfroidt G, Moberg D, Robba C, Rosenthal ES, Smielewski P, Wainwright MS, and Park S
Published: 2024
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