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This article explores the implementation of CPPopt in the NCCU in Porto, focusing on its application in different clinical scenarios such as traumatic brain injury, intracranial hypertension, subarachnoid hemorrhage, and more. It also discusses the use of ICM+ in multidisciplinary clinical research and the challenges and future expectations of teamwork in the NCCU. The article includes information on CPP management, data mining, clinical decision support systems, and continuous noninvasive monitoring of autoregulation.
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Teamwork with ICM+ in Porto Clinical Practice and Research at the NCCU Multidisciplinary Teamwork celeste.dias@med.up.pt Celeste Dias
CPPopt: visual analysis and decisionsteps Clinical Decision Support System approach: • CPPopt value and curve, updated every minute, in a 4 hr calculation window • at least 75% of time good recordings of CPP and ICP values had to be available in the 4hr calculation window • average PRx values had to be < 0.25 the past 4hrs • select the CPP value with most negative PRx value covered by the curve. • U-shaped, ascendinganddescending curves were accepted in case the overall PRx<0.25. 'CPPopt' in clinical practice in a NCCU: how do I do it with ICM+ in Porto
TBI: CPPopt and CPP management Female, 20y, TBI, GCS 4 • CPP management: • When possible, we guided CPP management using the bedside CPPopt values. • When CPPopt was not available, we kept CPP between 50-70 mmHg in accordance to BFT Guidelines. • To achieve higher CPPopt values, volume expansion in combination with norepinephrine were used at the discretion of the physician in charge • lower CPPopt values with decreasing vasopressor therapy, treating intracranial hypertension or increasing sedation. 'CPPopt' in clinical practice in a NCCU: how do I do it with ICM+ in Porto
ICHypertension: CPPopt, ICP and CPP management • Intracranial hypertension management: • ICP above 20 mmHg was treated initially with first-tier therapy (deep sedation, paralysis, normothermia, mild hyperventilation and when possible cerebral spinal fluid drainage after insertion of extra ventricular drain (EVD)). • If ICP remained above 20 mmHg for more than 20 minutes, osmotherapy was administered (mannitol or hypertonic saline bolus). • In cases of refractory intracranial hypertension second-tier therapy (hypothermia, profound hyperventilation and surgical decompression) was applied 'CPPopt' in clinical practice in a NCCU: how do I do it with ICM+ in Porto
SAH: CPPopt, pbtO2 and CPP management 'CPPopt' in clinical practice in a NCCU: how do I do it with ICM+ in Porto
ICM+ otherclinicalapplications Impaired Autoregulation: CO2 vasoreactivity, CPPopt and CPP management Brain death, PRx solid red line and RAP 'CPPopt' in clinical practice in a NCCU: how do I do it with ICM+ in Porto
ICM + and HRV ICM + and multidisciplinary clinical research in Porto
ICM + and orthostatism in ABI patients ICM + and clinical research in Porto
CPPopt vs CPP and outcome at 6M • 6M outcome of patients with severe TBI and spontaneous SAH • Patients at NCCU are managed according to CPPopt • Patients at the other 2 ICU’s are managed according to guidelines • No difference between age, gender and severity scores between groups p<0,001 ICM + and clinical research in the Intensive Care Department
ICM + and Teamwork at NCCU NCCU Teamwork: the ultimate challenge
ICM + and myfutureexpectations ICM+ Advanced Instructions Manual with math methods used Data Mining and Clinical Decision Support System Automatic Integration with Clinical Data from other Softwares PRx, other indexes and CPPopt CPP opt Management Clinical Validation Continuous Noninvasive Monitoring of Autoregulation Thanks for your attention
