Clinical application of non-invasive intracranial pressure measurements

Sheehan, James Robert; Liu, X.; Donnelly, Joseph E.; Cardim, Danilo; Czosnyka, Marek; Robba, Chiara

doi:10.1016/j.bja.2018.04.017

Cited by 10 publications

(5 citation statements)

References 12 publications

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“…Ultrasound-based techniques have garnered significant attention for nICP assessment in recent years, principally in neurotrauma patients [9,14,[43][44][45], but also in non-neurotrauma related pathologies [16,22,46]. Specifically, ONSD ultrasonography has demonstrated robust diagnostic accuracy in detecting intracranial hypertension [44] with an optimal ONSD cut-off value to be 5. monitored ICP in our study.…”

Section: Discussionmentioning

confidence: 99%

A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest

et al. 2019

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Aim: Increased intracranial pressure (ICP) in hypoxic ischaemic brain injury (HIBI) can cause secondary ischaemic brain injury and culminate in brain death. Invasive ICP monitoring is limited by associated risks in HIBI patients. We sought to evaluate the agreement between invasive ICP measurements and non-invasive estimators of ICP (nICP) in HIBI patients. Methods: Eligible consecutive adult (age > 18) cardiac arrest patients with HIBI were included as part of a single center prospective interventional study. Invasive ICP monitoring was undertaken and nICP measurements were undertaken using: a) transcranial Doppler ultrasonography (TCD), b) optic nerve sheet diameter ultrasound (ONSD) and c) jugular venous bulb pressure (JVP). Multiple measurements applied in linear mixed-effects models were considered to obtain the correlation coefficient between ICP and nICP as well as their prediction ability to detect intracranial hypertension (ICP ≥20 mm Hg). Results: Eleven patients were included (median age of 47 [range 20-71], 8 male and 3 female). There was a linear relationship between ICP and nICP with ONSD (R=0.53 [p<0.0001]), JVP (R=0.38 [p<0.001]) and TCD (R=0.30 [p<0.01]). The ability to predict intracranial hypertension was highest for ONSD and TCD (AUC=0.96 [95% CI: 0.90-1.00] and AUC=0.91 [95% CI: 0.83-1.00], respectively). JVP presented the weakest prediction ability (AUC=0.75 [95% CI: 0.56-0.94]). Conclusions: ONSD and TCD methods demonstrated agreement with invasively-monitored ICP, suggesting their potential roles in the detection of intracranial hypertension in HIBI after cardiac arrest.

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Section: Discussionmentioning

confidence: 99%

A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest

et al. 2019

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“…Robba et al previously observed a prediction power improvement of combining TCD, pupillometry and optic nerve sheath ultrasound, rather than using such techniques separately 17,31 TCD was concentrated in the past on the PI as maker of raised ICP 32 . Notwithstanding, many studies brought controversial results for the PI in this regard, concluding this parameter to be more an indicator of reduced CPP (when PI is raised > 1.4) than elevated ICP 33 .…”

Section: Discussionmentioning

confidence: 99%

Predicting short-term outcomes in brain-Injured patients: A comprehensive approach with transcranial Doppler and intracranial compliance assessment

Brasil,

Cardim,

Caldas

et al. 2023

Preprint

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Background Neurocritical patients frequently exhibit abnormalities in cerebral hemodynamic (CH) impairment and/or intracranial compliance (ICC), all of which significantly impact their clinical outcomes. Transcranial Doppler (TCD) and the cranial micro-deformation sensor (B4C) are valuable techniques for assessing CH and ICC, respectively. However, there is a scarcity of data regarding the predictive value of these techniques in determining patient outcomes. Methods We prospectively included neurocritical patients undergoing intracranial pressure (ICP) monitoring within the first 5 days of hospital admission for TCD and B4C assessments. Comprehensive clinical data were collected alongside parameters obtained from TCD (including blood velocities, pulsatility index, estimated ICP - eICP and estimated cerebral perfusion pressure - eCPP]) and B4C (measured as the P2/P1 ratio). These parameters were evaluated individually as well as in combination. These parameters were evaluated alone as well as in combinations among them. The short-term outcomes (STO) of interest were the therapy intensity levels (til) for icp management recommended by the SIBICC, as TIL 0 (STO 1), TIL 1–3 (STO 2) and death (STO 3), at the seventh day after last data collection. Results A total of 98 patients were included, with 67% having experienced traumatic brain injury; ICP, P2/P1, and eCPP demonstrated the highest ability to predict early mortality (p = 0.02, p = 0.02, and p = 0.006, respectively). P2/P1 was the only parameter significant for the prediction of STO 1 (p = 0.03). Combining B4C and TCD parameters, the highest areas under the curve (AUC) were 0.85 to predict death (STO 3), using P2/P1 + eCPP, whereas AUC was 0.72 to identify ICP > 20 mmHg using P2/P1 + eICP. Conclusion The combined noninvasive neuromonitoring approach using TCD and B4C demonstrated improved performance in predicting outcomes during the early phase after acute brain injury. Correlation between these parameters and intracranial hypertension was moderate, supporting the role of multimodal neuromonitoring as ancillary information in the ICU. Trial registration NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219

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“…Research into more advanced and innovative noninvasive tools is necessary. This is especially significant since earlier studies of these ultrasound techniques suggested high accuracy, leading to adoption in clinical practice at several centers, including our own, often as components of noninvasive monitoring protocols ( 22 , 23 ). While TCCS may have a role in the multimodal bedside assessment of ICP and adequacy of brain perfusion when invasive monitoring cannot be used, it should not be used as the sole criterion for clinical decision-making.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Color-Coded Sonography With Angle Correction As a Screening Tool for Raised Intracranial Pressure

Rajajee,

Soroushmehr,

Williamson

et al. 2023

Critical Care Explorations

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OBJECTIVES: Transcranial Doppler (TCD) has been evaluated as a noninvasive intracranial pressure (ICP) assessment tool. Correction for insonation angle, a potential source of error, with transcranial color-coded sonography (TCCS) has not previously been reported while evaluating ICP with TCD. Our objective was to study the accuracy of TCCS for detection of ICP elevation, with and without the use of angle correction. DESIGN: Prospective study of diagnostic accuracy. SETTING: Academic neurocritical care unit. PATIENTS: Consecutive adults with invasive ICP monitors. INTERVENTIONS: Ultrasound assessment with TCCS. MEASUREMENTS AND MAIN RESULTS: End-diastolic velocity (EDV), time-averaged peak velocity (TAPV), and pulsatility index (PI) were measured in the bilateral middle cerebral arteries with and without angle correction. Concomitant mean arterial pressure (MAP) and ICP were recorded. Estimated cerebral perfusion pressure (CPP) was calculated as estimated CPP (CPPe) = MAP × (EDV/TAPV) + 14, and estimated ICP (ICPe) = MAP–CPPe. Sixty patients were enrolled and 55 underwent TCCS. Receiver operating characteristic curve analysis of ICPe for detection of invasive ICP greater than 22 mm Hg revealed area under the curve (AUC) 0.51 (0.37–0.64) without angle correction and 0.73 (0.58–0.84) with angle correction. The optimal threshold without angle correction was ICPe greater than 18 mm Hg with sensitivity 71% (29–96%) and specificity 28% (16–43%). With angle correction, the optimal threshold was ICPe greater than 21 mm Hg with sensitivity 100% (54–100%) and specificity 30% (17–46%). The AUC for PI was 0.61 (0.47–0.74) without angle correction and 0.70 (0.55–0.92) with angle correction. CONCLUSIONS: Angle correction improved the accuracy of TCCS for detection of elevated ICP. Sensitivity was high, as appropriate for a screening tool, but specificity remained low.

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Clinical application of non-invasive intracranial pressure measurements

Cited by 10 publications

References 12 publications

A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest

A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest

Predicting short-term outcomes in brain-Injured patients: A comprehensive approach with transcranial Doppler and intracranial compliance assessment

Transcranial Color-Coded Sonography With Angle Correction As a Screening Tool for Raised Intracranial Pressure

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