1. Clinical Practice and Research at the NCCU Multidisciplinary Teamwork
Teamwork with ICM+ in Porto
Clinical Practice and Research at the NCCU
Multidisciplinary Teamwork
Celeste Dias

2. CPPopt: visual analysis and decision steps
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, ascending and descending 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

3. 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 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

4. 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

5. SAH: CPPopt, pbtO2 and CPP management
'CPPopt' in clinical practice in a NCCU: how do I do it with ICM+ in Porto

6. ICM+ other clinical applications
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

7. ICM + and multidisciplinary clinical research in Porto
ICM + and HRV
ICM + and multidisciplinary clinical research in Porto

8. ICM + and orthostatism in ABI patients
ICM + and clinical research in Porto

9. 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
NCCU
n, (%)
General ICU
Surgical ICU
Bad outcome (GOS 1, 2, 3)
15 (14%)
41 (38%)
52 (33%)
Good outcome (GOS 4,5)
50 (47%)
35 (33%)
22 (21%) 65 76 74
ICM + and clinical research in the Intensive Care Department

10. ICM + and Teamwork at NCCU
NCCU Teamwork: the ultimate challenge

11. Thanks for your attention
ICM + and my future expectations
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