Modelling in Medicine and Biology VI
Brain damage -- Computer simulation, Intracranial pressure -- Measurement, Clinical trials -- Computer simulation
We used a prospective clinical trial to generate physiologic data to create subject-specific in silico (computer simulation) models of intracranial pressure dynamics in children with severe traumatic brain injury. The trial included a physiologic challenge protocol with changes in head-of-bed elevation and minute ventilation, applied over multiple iterations to three subjects. Physiologic signals (electrocardiogram, respiration, arterial blood pressure, intracranial pressure [ICP], oxygen saturation) were recorded continuously, along with clinical annotations indicating the precise timing of physiologic challenges. Several parameters within the model of ICP dynamics were estimated for each subject based on the ICP response to the challenges. Estimation was done using a standard optimization algorithm to minimize the difference between the ICP trajectory predicted by the model and the actual ICP data. The ICP trajectory predicted by the model was similar to the actual ICP data in all cases, and the mean absolute error varied between 0.5 - 2.8 mmHg (mean = 1.4mmHg). These results demonstrate the potential for using clinically annotated prospective data to create subject-specific computer simulation models. Future research will focus on improvements in the logic for cerebral autoregulatory mechanisms and physiologic adaptation.
Wakeland, W., Fusion, J., and Goldstein, B. (2005). Estimation of Subject Specific ICP Dynamic Models Using Prospective Clinical Data. Modelling in Medicine and Biology VI, Vol 8.