[학회발표] 2024년 추계 신경외과 학회

[학회구연발표]

발표자: 정현철 임상강사

일시: 2024.10.18 오후 16:40

장소: 인터컨티넨탈 파르나스

주제: Pressure reactivity index (PRx) and ‘optimal cerebral perfusion’ landscape and limitation in neurocritical care

Authors :

Seungjoo Lee 1, Moinay Kim 1, Hyunjoo Ryu 1

Affiliations :

Ulsan University Asan Medical Center1

Abstract Title :

SS(II2)-5 Pressure reactivity index (PRx) and ‘optimal cerebral perfusion’ landscape and limitation in neurocritical care

Purpose :

This study introduces a method to define an 'optimal' cerebral perfusion pressure (CPPopt) as the CPP value that corresponds to the highest autoregulatory capacity. This is determined by analyzing the pressure reactivity index (PRx) and CPP relationship, which typically shows a U-shaped curve but is often obscured by noise and incomplete data. Our approach involves creating a color-coded map that illustrates the PRx-CPP relationship over several hours, enhancing its clarity for bedside display. This method is a condensed version of a comprehensive study published in Critical Care Medicine, offering new insights and a unique bedside application, initially presented at the Intracranial Pressure Symposium in Boston.

Methods :

Data from routine monitoring of traumatic brain injury patients were analyzed using the ICM+ software. We calculated and recorded time-averaged values for arterial blood pressure, intracranial pressure, CPP, and PRx at one-minute intervals. The ICM+ software was enhanced to include not only an automated CPPopt calculation algorithm but also a visual 'CPPopt landscape' chart.

Result :

The 'CPPopt landscape' chart enables clinicians to distinguish between periods of narrow autoregulatory range, which require precise targeting, and periods of general hemodynamic stability, where CPP management can be more flexible. This level of detail surpasses what was possible with previous visualization methods.

Conclusion :

Our study expands on the concept of autoregulatory assessment by providing a retrospective view of the PRx-CPP relationship over several hours. This visualization has been integrated into the ICM+ software for real-time use. The new visualization approach is expected to enhance clinical evaluation and the application of autoregulation-guided therapy.