Avaliação da pressão de perfusão cerebral e da autorregulação cerebral dinâmica por meio da decomposição do índice de vasorreatividade cerebral (PRX) em pacientes neurocríticos

Abstract

The Intracranial hypertension (ICH) is a neurological condition that primarily affects patients with Traumatic Brain Injury (TBI), cerebrovascular accident (CVA) and hydrocephalus. Currently, the most suitable treatment of this condition requires continuous monitoring of brain clinical parameters associated with cerebral perfusion. In this context, two variables are highly relevant in clinical evaluations: intracranial pressure (ICP) and mean arterial pressure (MAP). There is a technological need, both nationally and internationally, of a system to obtain information from the PIC and the MAP in order to improve the monitoring of patients in neurological intensive care units. In this context, this research proposed the development of a computational tool able to provide relevant clinical parameters to monitor the evolution of patients. The software provides the correlation of PIC waveform with mean arterial pressure by setting the cerebral perfusion pressure more ideal for every patient assessed, using the Pearson correlation coefficient after scanning of said analog signals (PIC and PAM) to 0.06 Hz (low-PRx). The system interface displays the following parameters: ICP, MAP, cerebral perfusion pressure (CPP), cerebral vasoreactivity index (PRx) and further assesses the decomposition of PRx using the decomposition method of empirical oscillations (English, Empirical Mode Decomposition). To illustrate the application of the tool developed was conducted a case study concerning a five patients sampling monitored in the ICU of a referral hospital. The use of the developed tool enabled the evaluation of the most appropriate PPC for each patient assessed, and the results compared with those provided by Glasgow Prognostic Scale (English, GOS - Glasgow Outcome Scale). The developed tool is useful in evaluating the ICP, CPP and PRx in patients monitored in the neurological ICU.