Meaning of Intracranial Pressure-to-Blood Pressure Fisher-Transformed Pearson Correlation-Derived Optimal Cerebral Perfusion Pressure: Testing Empiric Utility in a Mechanistic Model

Critical Care Medicine
Alireza Akhondi-AslRobert C Tasker

Abstract

Time-averaged intracranial pressure-to-blood pressure Fisher-transformed Pearson correlation (PRx) is used to assess cerebral autoregulation and derive optimal cerebral perfusion pressure. Empirically, impaired cerebral autoregulation is considered present when PRx is positive; greater difference between time series median cerebral perfusion pressure and optimal cerebral perfusion pressure (ΔCPP) is associated with worse outcomes. Our aims are to better understand: 1) the potential strategies for targeting optimal cerebral perfusion pressure; 2) the relationship between cerebral autoregulation and PRx; and 3) the determinants of greater ΔCPP. Mechanistic simulation using a lumped compartmental model of blood pressure, intracranial pressure, cerebral autoregulation, cerebral blood volume, PaCO2, and cerebral blood flow. University critical care integrative modeling and precision physiology research group. None, in silico studies. Simulations in blood pressure, intracranial pressure, PaCO2, and impairment of cerebral autoregulation, with examination of "output" cerebral perfusion pressure versus PRx-plots, optimal cerebral perfusion pressure, and ΔCPP. In regard to targeting optimal cerebral perfusion pressure, a shift in mean bl...Continue Reading

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