Toward comprehensive multimodal neuromonitoring of surrogates of cerebral autoregulation in traumatic brain injury: insights from a hyperventilation protocol.

Overview

1. ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
2. Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
3. Vall d’Hebron University Hospital, Neurotrauma Intensive Care Unit, Barcelona, Spain
4. Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
5. Vall d’Hebron University Hospital, Department of Neurosurgery, Barcelona, Spain
6. Universitat Autònoma de Barcelona, Barcelona, Spain
7. Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain

Abstract

Significance: It is hypothesized that neurocritical-care targeting cerebral autoregulation (CAR) would lead to improved outcomes. However, there is no single accepted CAR index due to limited accessibility of the methods and the complexity of interpretation. It is imperative to introduce accessible and direct methods.

Aim: We aim to compare traditional CAR indices and those on hybrid near-infrared diffuse optical (DO) monitors on a clinical population undergoing a controlled intervention.

Approach: Traumatic brain injury patients undergoing a hyperventilation protocol were monitored. Seven CAR indices based on the common correlation approach were derived. The detection of CAR alteration by hyperventilation, their variability, and the simultaneity of the detected changes were quantified.

Results: Seventeen patients have been monitored, showing a predominant decrease in CAR due to hyperventilation in some but not all indices. The quantified variability has demonstrated that DO-based indices could be more sensitive to small changes, and a compound “agreement score” has indicated that most recordings (18/20) displayed directional consistency, supporting the robustness of multimodal assessment.

Conclusions: We have demonstrated that different CAR indices lead to different interpretations and further analysis and clinical trials are merited. We call for the release of open data-sets to enable this.

Reproduced under the paper's license (CC BY), from the paper cited above.

Code

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Data

Datasets cited

• zenodo:22133950, at Zenodo; found in “Code and Data Availability”

Code and Data Availability

Data are available in the Zenodo repository at https://doi.org/10.5281/zenodo.22133950.

Reproduced under the paper's license (CC BY), from the paper cited above.

Versions

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Version 2, 28 September 2026

• Funding: added Centres de Recerca de Catalunya; Laserlab-Europe: 871124; European Commission: 871124, 101016087, 101099093, 101099291, 101017113, 675332, EC H2020; Generalitat de Catalunya: 871124; Agència de Gestió d'Ajuts Universitaris i de Recerca: 871124; Agencia Estatal de Investigación

Version 1, 27 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 11 authors, 4 keywords, 120 references.

Cite

This paper

Tagliabue, S., Ruiz, M. M., Fischer, J. B., Maruccia, F., Rey-Perez, A., Exposito, L., Baguena, M., Kainerstorfer, J. M., Sahuquillo, J., Poca, M. A., & Durduran, T. (2026). Toward comprehensive multimodal neuromonitoring of surrogates of cerebral autoregulation in traumatic brain injury: insights from a hyperventilation protocol. Neurophotonics, 13(3), 035010. https://doi.org/10.1117/1.nph.13.3.035010

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