J Clin Monit Comput - Reduced complexity of intracranial pressure observed in short time series of intracranial hypertension following traumatic brain injury in adults.

Tópicos

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Resumo

Physiological parameters, such as intracranial pressure (ICP), are regulated by interconnected feedback loops, resulting in a complex time course. According to the decomplexification theory, disease is characterised by a loss of feedback loops resulting in a reduced complexity of the time course of physiological parameters. We hypothesized that complexity of the ICP time series is decreased during periods of intracranial hypertension (IHT) following adult traumatic brain injury. In an observational retrospective cohort study, ICP was continuously monitored using intraparenchymally implanted probes and stored using ICM + -software. Periods of IHT (ICP > 25 mmHg for at least 1,024 s), were compared with preceding periods of intracranial normotension (ICP < 20 mmHg) and analysed at 1 s-intervals. ICP data (length = 1,024 s) were normalised (mean = 0, SD = 1) and complexity was estimated using the scaling exponent a (as derived from detrended fluctuation analysis), sample entropy (SampEn, m = 1, r = 0.2 ? SD) and multiscale entropy. 344 episodes were analysed in 22 patients. During IHT (ICP = 31.7 ? 7.8 mmHg, mean ? SD), a was significantly elevated (a = 1.02 ? 0.22, p < 0.001) and SampEn significantly reduced (SampEn = 1.45 ? 0.46, p = 0.004) as compared to before IHT (ICP = 15.7 ? 3.2 mmHg, a = 0.81 ? 0.14, SampEn = 1.81 ? 0.24). In addition, MSE revealed a significantly (p < 0.05) decreased entropy at scaling factors ranging from 1 to 10. Both the increase in a as well as the decrease in SampEn and MSE indicate a loss of ICP complexity. Therefore following traumatic brain injury, periods of IHT seem to be characterised by a decreased complexity of the ICP waveform.

Resumo Limpo

physiolog paramet intracrani pressur icp regul interconnect feedback loop result complex time cours accord decomplexif theori diseas characteris loss feedback loop result reduc complex time cours physiolog paramet hypothes complex icp time seri decreas period intracrani hypertens iht follow adult traumat brain injuri observ retrospect cohort studi icp continu monitor use intraparenchym implant probe store use icm softwar period iht icp mmhg least s compar preced period intracrani normotens icp mmhg analys sinterv icp data length s normalis mean sd complex estim use scale expon deriv detrend fluctuat analysi sampl entropi sampen m r sd multiscal entropi episod analys patient iht icp mmhg mean sd signific elev p sampen signific reduc sampen p compar iht icp mmhg sampen addit mse reveal signific p decreas entropi scale factor rang increas well decreas sampen mse indic loss icp complex therefor follow traumat brain injuri period iht seem characteris decreas complex icp waveform

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