16
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      A Patient-Independent Significance Test by Means of False-Positive Rates in Selected Correlation Analysis of Brain Multimodal Monitoring Data

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Recently, we introduced a mathematical toolkit called selected correlation analysis (sca) that reliably detects negative and positive correlations between arterial blood pressure (ABP) and intracranial pressure (ICP) data, recorded during multimodal monitoring, in a time-resolved way. As has been shown with the aid of a mathematical model of cerebral perfusion, such correlations reflect impaired autoregulation and reduced intracranial compliance in patients with critical neurological diseases. Sca calculates a Fourier transform-based index called selected correlation (sc) that reflects the strength of correlation between the input data and simultaneously an index called mean Hilbert phase difference (mhpd) that reflects the phasing between the data. To reliably detect pathophysiological conditions during multimodal monitoring, some thresholds for the abovementioned indexes sc and mhpd have to be established that assign predefined significance levels to that thresholds. In this paper, we will present a method that determines the rate of false positives for fixed pairs of thresholds (lsc, lmhpd). We calculate these error rates as a function of the predefined thresholds for each individual out of a patient cohort of 52 patients in a retrospective way. Based on the deviation of the individual error rates, we subsequently determine a globally valid upper limit of the error rate by calculating the predictive interval. From this predictive interval, we deduce a globally valid significance level for appropriate pairs of thresholds that allows the application of sca to every future patient in a prospective, bedside fashion.

          Related collections

          Most cited references23

          • Record: found
          • Abstract: found
          • Article: not found

          A review of multitaper spectral analysis.

          Nonparametric spectral estimation is a widely used technique in many applications ranging from radar and seismic data analysis to electroencephalography (EEG) and speech processing. Among the techniques that are used to estimate the spectral representation of a system based on finite observations, multitaper spectral estimation has many important optimality properties, but is not as widely used as it possibly could be. We give a brief overview of the standard nonparametric spectral estimation theory and the multitaper spectral estimation, and give two examples from EEG analyses of anesthesia and sleep.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Understanding secondary injury.

            Secondary injury is a term applied to the destructive and self-propagating biological changes in cells and tissues that lead to their dysfunction or death over hours to weeks after the initial insult (the "primary injury"). In most contexts, the initial injury is usually mechanical. The more destructive phase of secondary injury is, however, more responsible for cell death and functional deficits. This subject is described and reviewed differently in the literature. To biomedical researchers, systemic and tissue-level changes such as hemorrhage, edema, and ischemia usually define this subject. To cell and molecular biologists, "secondary injury" refers to a series of predominately molecular events and an increasingly restricted set of aberrant biochemical pathways and products. These biochemical and ionic changes are seen to lead to death of the initially compromised cells and "healthy" cells nearby through necrosis or apoptosis. This latter process is called "bystander damage." These viewpoints have largely dominated the recent literature, especially in studies of the central nervous system (CNS), often without attempts to place the molecular events in the context of progressive systemic and tissue-level changes. Here we provide a more comprehensive and inclusive discussion of this topic.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Individualizing Thresholds of Cerebral Perfusion Pressure Using Estimated Limits of Autoregulation

              Objectives In severe traumatic brain injury (TBI), cerebral perfusion pressure (CPP) management based on cerebrovascular pressure reactivity (PRx) has the potential to provide a personalised treatment target to improve patient outcomes. So far, the methods have focused on identifying one autoregulation guided CPP target – called CPPopt. We investigated whether a CPP autoregulation range - which uses a continuous estimation of the ‘lower’ and ‘upper’ CPP limits of cerebrovascular pressure autoregulation (PRx) - has prognostic value. Design Single-centre retrospective analysis of prospectively collected data Setting The neurocritical care unit at a tertiary academic medical centre Patients Data from 729 severe TBI patients admitted between 1996 and 2016 were used. Treatment was guided by controlling intracranial pressure and CPP according to a local protocol. Interventions None Methods and Main Results CPP-PRx curves were fitted automatically using a previously published curve-fitting heuristic from the relationship between PRx and CPP. The CPP values at which this ‘U-shaped curve’ crossed the fixed threshold from intact to impaired pressure reactivity (PRx =0.3) were denoted automatically the ‘Lower’ and ‘Upper’ CPP Limits of Reactivity (LLR and ULR), respectively. The % of time with CPP below (%CPP<LLR), above (%CPP>ULR) or within these reactivity limits (%CPP WLR) was calculated for each patient and compared across dichotomised Glasgow Outcome Scores. After adjusting for age, initial GCS, and mean ICP, %CPP<LLR was associated with unfavourable outcome (OR %CPP<LLR 1.04, 95%-CI 1.02-1.06, p <0.001) and mortality (OR 1.06 95%-CI 1.04-1.08, p<0.001). Conclusions Individualised autoregulation-guided CPP management may be a plausible alternative to fixed CPP threshold management in severe TBI patients. Prospective randomized research will help to define which autoregulation guided method is beneficial, safe and most practical.
                Bookmark

                Author and article information

                Contributors
                Journal
                Comput Math Methods Med
                Comput Math Methods Med
                CMMM
                Computational and Mathematical Methods in Medicine
                Hindawi
                1748-670X
                1748-6718
                2018
                8 August 2018
                : 2018
                : 6821893
                Affiliations
                1Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
                2Department of Neurosurgery, University Hospital Charite, Berlin, Germany
                Author notes

                Academic Editor: Michele Migliore

                Author information
                http://orcid.org/0000-0003-4658-6433
                http://orcid.org/0000-0001-9284-0282
                http://orcid.org/0000-0001-9887-3165
                Article
                10.1155/2018/6821893
                6109537
                8c234197-680b-4ae8-b7d7-a2bd68f1e9ac
                Copyright © 2018 Rupert Faltermeier et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 March 2018
                : 20 June 2018
                : 11 July 2018
                Categories
                Research Article

                Applied mathematics
                Applied mathematics

                Comments

                Comment on this article