Intracranial pressure monitoring in diffuse brain injury—why the developing world needs it more?

Vora, Tarang K.; Karunakaran, Sudish; Kumar, Ajay; Chiluka, Anil; Srinivasan, H.; Parmar, Kanishk; Vasu, Srivatsan Thirumalai; Srinivasan, Rahul; Chandan, H. A.; Vishnu, P. S.; Raheja, Lakshay

doi:10.1007/s00701-018-3538-4

Cited by 9 publications

(3 citation statements)

References 18 publications

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“…In the general ICU population, especially in cardiac arrest patients or in metabolic coma and liver failure, ICP tcd can be an important tool for the early diagnosis and treatment of cerebral complications [ 32 ]. Another field where a noninvasive ICP monitoring technique would be most useful would be developing countries where access to hospitals with resources for invasive ICP monitoring is scarce [ 33 , 34 ]. Finally, in patients at risk for intracranial hypertension, repeated TCD assessment is easily implemented and may represent the primary monitoring method if ICP tcd remains low.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Doppler as a screening test to exclude intracranial hypertension in brain-injured patients: the IMPRESSIT-2 prospective multicenter international study

et al. 2022

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Background Alternative noninvasive methods capable of excluding intracranial hypertension through use of transcranial Doppler (ICPtcd) in situations where invasive methods cannot be used or are not available would be useful during the management of acutely brain-injured patients. The objective of this study was to determine whether ICPtcd can be considered a reliable screening test compared to the reference standard method, invasive ICP monitoring (ICPi), in excluding the presence of intracranial hypertension. Methods This was a prospective, international, multicenter, unblinded, diagnostic accuracy study comparing the index test (ICPtcd) with a reference standard (ICPi), defined as the best available method for establishing the presence or absence of the condition of interest (i.e., intracranial hypertension). Acute brain-injured patients pertaining to one of four categories: traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) or ischemic stroke (IS) requiring ICPi monitoring, were enrolled in 16 international intensive care units. ICPi measurements (reference test) were compared to simultaneous ICPtcd measurements (index test) at three different timepoints: before, immediately after and 2 to 3 h following ICPi catheter insertion. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated at three different ICPi thresholds (> 20, > 22 and > 25 mmHg) to assess ICPtcd as a bedside real-practice screening method. A receiver operating characteristic (ROC) curve analysis with the area under the curve (AUC) was used to evaluate the discriminative accuracy and predictive capability of ICPtcd. Results Two hundred and sixty-two patients were recruited for final analysis. Intracranial hypertension (> 22 mmHg) occurred in 87 patients (33.2%). The total number of paired comparisons between ICPtcd and ICPi was 687. The NPV was elevated (ICP > 20 mmHg = 91.3%, > 22 mmHg = 95.6%, > 25 mmHg = 98.6%), indicating high discriminant accuracy of ICPtcd in excluding intracranial hypertension. Concordance correlation between ICPtcd and ICPi was 33.3% (95% CI 25.6–40.5%), and Bland–Altman showed a mean bias of -3.3 mmHg. The optimal ICPtcd threshold for ruling out intracranial hypertension was 20.5 mmHg, corresponding to a sensitivity of 70% (95% CI 40.7–92.6%) and a specificity of 72% (95% CI 51.9–94.0%) with an AUC of 76% (95% CI 65.6–85.5%). Conclusions and relevance ICPtcd has a high NPV in ruling out intracranial hypertension and may be useful to clinicians in situations where invasive methods cannot be used or not available. Trial registration: NCT02322970.

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Section: Discussionmentioning

confidence: 99%

Transcranial Doppler as a screening test to exclude intracranial hypertension in brain-injured patients: the IMPRESSIT-2 prospective multicenter international study

et al. 2022

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“…In the general ICU population, especially in cardiac arrest patients or in metabolic coma and liver failure, ICPtcd can be an important tool for the early diagnosis and treatment of cerebral complications [32]. Another field where a noninvasive ICP monitoring technique would be most useful would be developing countries where access to hospitals with resources for invasive ICP monitoring is scarce [33,34]. Finally, in patients at risk for intracranial hypertension, repeated TCD assessment is easily implemented and may represent the primary monitoring method if ICPtcd remains low.…”

Section: Discussionmentioning

confidence: 99%

Trans-Cranial Doppler as a Screening Test to Exclude Intracranial Hypertension in Brain Injured Patients: The IMPRESSIT-2 Prospective Multicenter International Study

et al. 2021

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“…The allocation of the budget should be streamlined with the function outcome of patients and for that this monitoring must be an integral part of any NCC unit. 10 Neuromonitoring, paramedical staff and standard equipment is the backbone for any SOP based treatment, which results in better care.…”

Section: Discussionmentioning

confidence: 99%

5 Years Mortality of Severe Traumatic Brain Injury during the Establishment of Closed System Neurocritical Care Unit in a Resource Constrained Developing Country

et al. 2020

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Background & Objectives: Severe traumatic brain injury is one of the leading causes of mortality and morbidity.Efficient management of severe traumatic brain injury demands a specialty driven focused intensive care. We developed our model of closed ICU driven by Neurosurgical Neurointensivist and the corollary to thiscommitment is a TBI patient centered Neurocritical care with the capacity and capability to deal with most of the neurological illnesses.Materials & Methods: A prospective study was conducted to find out the impact of the establishment of closed system of neurocritical care on 5 year mortality of severe TBI. Total 1288 patients met the inclusion criteria, which were enrolled. Tabulation was done for gender, age range, Glasgow outcome scale and mortality.Results: It was observed that mortality reduced from 47% to 35% over a span of five years. The most common age range was 30-40 years, which is the most productive group of any population. Bed sore incidence is always on rise in any ICU. After the implementation of SOPs based management and increase in nursing staff theincidence of bedsore also showed a detrimental pattern from 35 % to 19%.Conclusion: Neurocritical care unit is proven to be an integral part of any neurosurgical unit and this closed system of NCC unit provide best SOP based care with significant reduction in mortality of patients with STBI.

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Intracranial pressure monitoring in diffuse brain injury—why the developing world needs it more?

Abstract: ICP monitoring-based treatment protocol helps in achieving faster recovery; lowers mortality rates in operated patients; and reduces ICU stay, radiation exposure, and the need for brain-specific treatment.

Cited by 9 publications

References 18 publications

Transcranial Doppler as a screening test to exclude intracranial hypertension in brain-injured patients: the IMPRESSIT-2 prospective multicenter international study

Transcranial Doppler as a screening test to exclude intracranial hypertension in brain-injured patients: the IMPRESSIT-2 prospective multicenter international study

Trans-Cranial Doppler as a Screening Test to Exclude Intracranial Hypertension in Brain Injured Patients: The IMPRESSIT-2 Prospective Multicenter International Study

5 Years Mortality of Severe Traumatic Brain Injury during the Establishment of Closed System Neurocritical Care Unit in a Resource Constrained Developing Country

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