@article{MTMT:30807695,
	title = {Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury : a CENTER-TBI analysis},
	url = {https://m2.mtmt.hu/api/publication/30807695},
	author = {Zeiler, Frederick A and Ercole, Ari and Beqiri, Erta and Cabeleira, Manuel and Aries, Marcel and Zoerle, Tommaso and Carbonara, Marco and Stocchetti, Nino and Smielewski, Peter and Czosnyka, Marek and Menon, David K},
	doi = {10.1007/s00701-019-03980-8},
	journal-iso = {ACTA NEUROCHIR},
	journal = {ACTA NEUROCHIRURGICA},
	volume = {161},
	unique-id = {30807695},
	issn = {0001-6268},
	abstract = {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.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.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.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 individualized physiologic targets (ICP, CPP, or Co2) in order to treat dysautoregulation actively.},
	keywords = {Cerebrovascular reactivity; TBI; TIL; PRx; Therapeutic intensity},
	year = {2019},
	eissn = {0942-0940},
	pages = {1955-1964},
	orcid-numbers = {Czeiter, Endre/0000-0002-9578-6944}
}

@article{MTMT:2906963,
	title = {Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study},
	url = {https://m2.mtmt.hu/api/publication/2906963},
	author = {Maas, AI and Menon, DK and Steyerberg, EW and Citerio, G and Lecky, F and Manley, GT and Hill, S and Legrand, V and Sorgner, A},
	doi = {10.1227/NEU.0000000000000575},
	journal-iso = {NEUROSURGERY},
	journal = {NEUROSURGERY},
	volume = {76},
	unique-id = {2906963},
	issn = {0148-396X},
	abstract = {BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE: To improve characterization and classification of TBI and to identify best clinical care, using comparative effectiveness research approaches. METHODS: This multicenter, longitudinal, prospective, observational study in 22 countries across Europe and Israel will collect detailed data from 5400 consenting patients, presenting within 24 hours of injury, with a clinical diagnosis of TBI and an indication for computed tomography. Broader registry-level data collection in approximately 20,000 patients will assess generalizability. Cross sectional comprehensive outcome assessments, including quality of life and neuropsychological testing, will be performed at 6 months. Longitudinal assessments will continue up to 24 months post TBI in patient subsets. Advanced neuroimaging and genomic and biomarker data will be used to improve characterization, and analyses will include neuroinformatics approaches to address variations in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research in TBI should provide novel multidimensional approaches to TBI characterization and classification, evidence to support treatment recommendations, and benchmarks for quality of care. Data and sample repositories will ensure opportunities for legacy research. DISCUSSION: Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support optimal personalized patient management.},
	year = {2015},
	eissn = {1524-4040},
	pages = {67-80},
	orcid-numbers = {Barzó, Pál/0000-0001-8717-748X; Czeiter, Endre/0000-0002-9578-6944}
}