Leveraging Continuous Vital Sign Measurements for Real-Time Assessment of Autonomic Nervous System Dysfunction After Brain Injury: A Narrative Review of Current and Future Applications

Podell, Jamie; Pergakis, Melissa; Yang, Shiming; Felix, Ryan; Parikh, Gunjan; Chen, Hegang; Chen, Lujie; Miller, Catriona; Hu, Peter; Badjatia, Neeraj

doi:10.1007/s12028-022-01491-6

“…Thus, modern MMM produces a high volume of data on multiple physiologic parameters, without a large degree of guidance for clinicians caring for patients with TBI. Several recent groups have advocated for the use of machine learning and “big data” analytic approaches to synthesize this information and classify patients into distinct physiologic states, allowing for an individualized yet systematic approach to treating the evolving physiologic derangements caused by TBI [ 13 , 204 , 205 ]. For example, while the BOOST-II trial was not statistically powered to guide outcomes-oriented treatment, a machine learning analysis of BOOST-II data used a combination of logistic regression, elastic net, and random forest machine learning methods to derive clinically applicable predictive models for ICP and brain oxygenation that could be used for early intervention and treatment of intracranial hypertension and hypoxia [ 206 ].…”

Section: Discussionmentioning

confidence: 99%

Multi-Mechanistic Approaches to the Treatment of Traumatic Brain Injury: A Review

Lynch

¹

,

Narayan

²

,

Li

³

2023

JCM

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Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Despite extensive research efforts, the majority of trialed monotherapies to date have failed to demonstrate significant benefit. It has been suggested that this is due to the complex pathophysiology of TBI, which may possibly be addressed by a combination of therapeutic interventions. In this article, we have reviewed combinations of different pharmacologic treatments, combinations of non-pharmacologic interventions, and combined pharmacologic and non-pharmacologic interventions for TBI. Both preclinical and clinical studies have been included. While promising results have been found in animal models, clinical trials of combination therapies have not yet shown clear benefit. This may possibly be due to their application without consideration of the evolving pathophysiology of TBI. Improvements of this paradigm may come from novel interventions guided by multimodal neuromonitoring and multimodal imaging techniques, as well as the application of multi-targeted non-pharmacologic and endogenous therapies. There also needs to be a greater representation of female subjects in preclinical and clinical studies.

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“…Thus modern MMM produces a high volume of data on multiple physiologic parameters, without a large degree of guidance for clinicians caring for patients with TBI. Several recent groups have advocated for the use of machine learning and "big data" analytic approaches to synthesize this information and classify patients into distinct physiologic states, allowing for an individualized yet systematic approach to treating the evolving physiologic derangements caused by TBI [11,168,169]. For example, while the BOOST-II trial was not statistically powered to guide outcomes-oriented treatment, a machine learning analysis of BOOST-II data used a combination of logistic regression, elastic net and random forest machine learning methods to derive clinically applicable predictive models for ICP and brain oxygenation that could be used for early intervention and treatment of intracanial hypertension and hypoxia [170].…”

Section: Imaging-and Neuromonitoring-guided Treatmentmentioning

confidence: 99%

Multi-mechanistic Approaches to the Treatment of Traumatic Brain Injury: A Review

Lynch¹,

Narayan²,

Li³

2023

Preprint

3

0

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Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Despite extensive research efforts, the majority of trialed monotherapies to date have failed to demonstrate significant benefit. It has been suggested that this is due to the complex pathophysiology of TBI, which may possibly be addressed by a combination of therapeutic interventions. In this article, we have reviewed combinations of different pharmacologic treatments, combinations of non-pharmacologic interventions, and combined pharmacologic and non-pharmacologic interventions for TBI. Both preclinical and clinical studies have been included. While promising results have been found in animal models, clinical trials of combination therapies have not yet shown clear benefit. This may possibly be due to their application without consideration of the evolving pathophysiology of TBI. Improvements of this paradigm may come from novel interventions guided by multimodal neuromonitoring and multimodal imaging techniques, as well as the application of multi-targeted non-pharmacologic and endogenous therapies. There also needs to be a greater representation of female subjects in preclinical and clinical studies.

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“…Particularly in high cervical and thoracic injuries, disruption of sympathetic outflow plays a key role in cardiovascular dysfunction [32]. Loss of supraspinal regulatory control of the sympathetic nervous system results in the reduced overall sympathetic activity below the level of injury and causes problems such as hypotension, bradycardia, and a diminished cardiovascular response to exercise [33][34][35]. Morphological changes occur in sympathetic preganglionic neurons distal to the lesion [36].…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Study on Spinal Cord Injuries in a Hospital from North-West of Romania

Fodor¹,

Voiță-Mekereș²,

Cheregi³

et al. 2023

Pharmacophore

5

0

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Leveraging Continuous Vital Sign Measurements for Real-Time Assessment of Autonomic Nervous System Dysfunction After Brain Injury: A Narrative Review of Current and Future Applications

Cited by 13 publications

References 95 publications

Multi-Mechanistic Approaches to the Treatment of Traumatic Brain Injury: A Review

Multi-Mechanistic Approaches to the Treatment of Traumatic Brain Injury: A Review

Multi-mechanistic Approaches to the Treatment of Traumatic Brain Injury: A Review

Epidemiological Study on Spinal Cord Injuries in a Hospital from North-West of Romania

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