Continuous monitoring of cerebral blood flow autoregulation in traumatic brain injury patients

Summary

Cerebral autoregulation is a physiological protective mechanism that ensure adequate cerebral blood supply to the brain despite fluctuations in arterial blood pressure (strictly speaking cerebral perfusion pressure, the difference between arterial blood pressure and the intracranial pressure, which is the driving force of the blood through the brain).  

This mechanism is critical as the neurons are highly susceptible to any period of starvation of oxygen and glucose, and the blood pressure variations are common and frequent. In addition, in traumatic brain injury, in the first days post injury, biochemical storm triggered by the initial brain injury/contusion leads to brain swelling, and thus increases in intracranial pressure and resulting in decreases in cerebral perfusion pressure. 

If the cerebral autoregulation is impaired the patients are thus subjected to ischaemic oxygen deprivation, episodes resulting ultimately in irreversible cellular damage further exacerbating the pathological processes. 

Continuous assessment of cerebral autoregulation, imperfect as it is at the moment, has been shown to be helpful in individualising management of arterial blood pressure in acute brain injury patients.  However, there exist many conceptual and technological problems that are stopping widespread adoption of this methodology. 

Project aims

The purpose of this project will be to investigate those pitfalls in the current techniques for continuous assessment of cerebral autoregulation, to develop more robust metrics based on a spectrum of methodological approaches, from signal processing, to probabilistic modelling to machine learning algorithms. 

The candidate will work with large retrospective data base of high-resolution waveforms collected in traumatic brain injury patients and managed by the Brain Physics lab as well as relevant datasets from collaborators. 

The project will also include practical implementation of algorithms and protocols for individualised management of patients in the intensive care or operating room scenarios, immediately applicable via our flagship neuro-monitoring software ICM+.

Contact details

Dr Peter Smielewski - ps10011@cam.ac.uk

Opportunities

This project is open to applicants who want to do a:

• PhD
• MPhil

This project would suit graduates in Biomedical Engineering, Signal Processing, Electrical Engineering, and Computer Science as well as mathematically minded medical graduates.