TY - JOUR AU - Zeiler, Frederick A AU - Ercole, Ari AU - Beqiri, Erta AU - Cabeleira, Manuel AU - Aries, Marcel AU - Zoerle, Tommaso AU - Carbonara, Marco AU - Stocchetti, Nino AU - Smielewski, Peter AU - Czosnyka, Marek AU - Menon, David K ED - Anke, Audny / Collaborator ED - Beer, Ronny / Collaborator ED - Bellander, Bo-Michael / Collaborator ED - Büki, András / Collaborator ED - Chevallard, Giorgio / Collaborator ED - Chieregato, Arturo / Collaborator ED - Citerio, Giuseppe / Collaborator ED - Czeiter, Endre / Collaborator ED - Depreitere, Bart / Collaborator ED - Eapen, George / Collaborator ED - Frisvold, Shirin / Collaborator ED - Helbok, Raimund / Collaborator ED - Jankowski, Stefan / Collaborator ED - Kondziella, Daniel / Collaborator ED - Koskinen, Lars-Owe / Collaborator ED - Meyfroidt, Geert / Collaborator ED - Moeller, Kirsten / Collaborator ED - Nelson, David / Collaborator ED - Piippo-Karjalainen, Anna / Collaborator ED - Radoi, Andreea / Collaborator ED - Ragauskas, Arminas / Collaborator ED - Raj, Rahul / Collaborator ED - Rhodes, Jonathan / Collaborator ED - Rocka, Saulius / Collaborator ED - Rossaint, Rolf / Collaborator ED - Sahuquillo, Juan / Collaborator ED - Sakowitz, Oliver / Collaborator ED - Stevanovic, Ana / Collaborator ED - Sundström, Nina / Collaborator ED - Takala, Riikka / Collaborator ED - Tamosuitis, Tomas / Collaborator ED - Tenovuo, Olli / Collaborator ED - Vajkoczy, Peter / Collaborator ED - Vargiolu, Alessia / Collaborator ED - Vilcinis, Rimantas / Collaborator ED - Wolf, Stefan / Collaborator ED - Younsi, Alexander / Collaborator TI - Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury : a CENTER-TBI analysis JF - ACTA NEUROCHIRURGICA J2 - ACTA NEUROCHIR VL - 161 PY - 2019 IS - 9 SP - 1955 EP - 1964 PG - 10 SN - 0001-6268 DO - 10.1007/s00701-019-03980-8 UR - https://m2.mtmt.hu/api/publication/30807695 ID - 30807695 N1 - Funding Agency and Grant Number: European Union 7th Framework program (EC) [602150]; Hannelore Kohl Stiftung (Germany); OneMind (USA); Integra LifeSciences Corporation (USA); National Institute for Health Research (NIHR, UK); Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust; NIHR Clinical Research network; University of Manitoba Thorlakson Chair in Surgical Research Establishment Fund; University of Manitoba VPRI Research Investment Fund (RIF); University of Manitoba Rudy Falk Clinician-Scientist Professorship; Health Sciences Centre Foundation Winnipeg Funding text: Data used in preparation of this manuscript were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Union 7th Framework program (EC grant 602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA) and from Integra LifeSciences Corporation (USA).; DKM was also supported by funding from the National Institute for Health Research (NIHR, UK) through a Senior Investigator award and the Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust. The study also received additional support from the NIHR Clinical Research network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care, UK. FAZ has received salary support for dedicated research time, during which this project was completed.; FAZ receives research support from the University of Manitoba Thorlakson Chair in Surgical Research Establishment Fund, the University of Manitoba VPRI Research Investment Fund (RIF), the University of Manitoba Rudy Falk Clinician-Scientist Professorship, and the Health Sciences Centre Foundation Winnipeg. AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Maas, AI AU - Menon, DK AU - Steyerberg, EW AU - Citerio, G AU - Lecky, F AU - Manley, GT AU - Hill, S AU - Legrand, V AU - Sorgner, A ED - Barzó, Pál / Collaborator ED - Büki, András / Collaborator ED - Czeiter, Endre / Collaborator ED - Demeter, B / Collaborator ED - Kalovits, F / Collaborator ED - Sándor, János / Collaborator ED - Szabo, J / Collaborator TI - Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study JF - NEUROSURGERY J2 - NEUROSURGERY VL - 76 PY - 2015 IS - 1 SP - 67 EP - 80 PG - 14 SN - 0148-396X DO - 10.1227/NEU.0000000000000575 UR - https://m2.mtmt.hu/api/publication/2906963 ID - 2906963 N1 - Funding Agency and Grant Number: Hannelore Kohl Foundation (Germany); Division Of Integrative Organismal Systems; Direct For Biological Sciences [1120912] Funding Source: National Science Foundation; Academy of Medical Sciences (AMS) [AMS-CSF4-Newcombe] Funding Source: researchfish; Medical Research Council [G9439390, G0601025, G0600986] Funding Source: researchfish; National Institute for Health Research [NF-SI-0512-10090, ACF-2009-14-007, 12/35/57, NIHR-RP-R3-12-013] Funding Source: researchfish; MRC [G0601025, G9439390, G0600986] Funding Source: UKRI Funding text: Funding of additional elements for this study has been provided by the Hannelore Kohl Foundation (Germany) and by the non-profit organization One Mind for Research (directly to International Neuroinformatics Coordinating Facility). The study registration is Clinicaltrials.gov: NCT02210221. AB - 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. LA - English DB - MTMT ER -