Noninvasive intracranial pressure real-time waveform analysis monitor during prostatectomy robotic surgery and Trendelenburg position: case report

Saba, Gabriela Tognini; Quintão, Vinícius Caldeira; Simões, Cláudia Marquez; Coelho, Rafael F.; Fazoli, Arnaldo; Nahas, William Carlos; Vilela, Gustavo Henrique Frigieri; Carmona, Maria José Carvalho

doi:10.1016/j.bjane.2021.09.003

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…In COVID-19 patients, the combination of P2/P1 with TCD allowed to identify disturbances in cerebral hemodynamics (CH) and predict early poor outcome [31]. Moreover, the application of this system in previously unexplored health conditions has suggested interesting alterations in brain compliance among patients with end-stage renal disease under hemodialysis [32] and robotic prostatectomy surgery because of Trendelenburg positioning [33].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

Brasil

Frigieri

Taccone

et al. 2022

J Clin Monit Comput

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Analysis of intracranial pressure waveforms (ICPW) provides information on intracranial compliance. We aimed to assess the correlation between noninvasive ICPW (NICPW) and invasively measured intracranial pressure (ICP) and to assess the NICPW prognostic value in this population. In this cohort, acute brain-injured (ABI) patients were included within 5 days from admission in six Intensive Care Units. Mean ICP (mICP) values and the P2/P1 ratio derived from NICPW were analyzed and correlated with outcome, which was defined as: (a) early death (ED); survivors on spontaneous breathing (SB) or survivors on mechanical ventilation (MV) at 7 days from inclusion. Intracranial hypertension (IHT) was defined by ICP > 20 mmHg. A total of 72 patients were included (mean age 39, 68% TBI). mICP and P2/P1 values were significantly correlated (r = 0.49, p < 0.001). P2/P1 ratio was significantly higher in patients with IHT and had an area under the receiving operator curve (AUROC) to predict IHT of 0.88 (95% CI 0.78–0.98). mICP and P2/P1 ratio was also significantly higher for ED group (n = 10) than the other groups. The AUROC of P2/P1 to predict ED was 0.71 [95% CI 0.53–0.87], and the threshold P2/P1 > 1.2 showed a sensitivity of 60% [95% CI 31–83%] and a specificity of 69% [95% CI 57–79%]. Similar results were observed when decompressive craniectomy patients were excluded. In this study, P2/P1 derived from noninvasive ICPW assessment was well correlated with IHT. This information seems to be as associated with ABI patients outcomes as ICP.Trial registration: NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219.

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Section: Discussionmentioning

confidence: 99%

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

Brasil

Frigieri

Taccone

et al. 2022

J Clin Monit Comput

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“…Apart from experimental and non-original papers, most of these articles were piloting the use of the device in patients with various neurological and non-neurological conditions. These included cryptococcal meningitis [5], renovascular hypertension [26], pediatric hydrocephalus [2], obesity [8], critical COVID-19 [10], end-stage renal disease [41], pregnancy [19], patients sedated for gastrointestinal endoscopy [24], sedentary chronic stroke patients [40], hemodialysis patients [42], prostatectomy surgery patients [45], fibromyalgia [33], cardiovascular surgery patients [1], diabetes and chronic kidney disease [35], and migraine [14]. To the best of our knowledge, this is the first prospective study to compare the Brain4Care noninvasive method with the invasive gold standard in TBI.…”

Section: Discussionmentioning

confidence: 99%

Can a new noninvasive method for assessment of intracranial pressure predict intracranial hypertension and prognosis?

et al. 2023

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Purpose Individuals with TBI are at risk of intracranial hypertension (ICH), and monitoring of intracranial pressure (ICP) is usually indicated. However, despite many new noninvasive devices, none is sufficiently accurate and effective for application in clinical practice, particularly in the management of TBIs. This study aimed to compare the noninvasive Brain4Care system (nICP) with invasive ICP (iICP) curve parameters in their ability to predict ICH and functional prognosis in severe TBI. Methods Observational, descriptive-analytical, and prospective study of 22 patients between 2018 and 2021, simultaneously monitored with nICP and iICP. The independent variables evaluated were the presence of ICH and functional prognoses. The dependent variables were the P2/P1 pressure ratio metrics, time to peak (TTP), and TTP × P2/P1. Results We found a good nonlinear correlation between iICP and nICP waveforms, despite a moderate Pearson’s linear correlation. The noninvasive parameters of P2/P1, P2/P1 × TTP, and TTP were not associated with outcomes or ICH. The nICP P2/P1 ratio showed sensitivity/specificity/accuracy (%) of 100/0/56.3, respectively for 1-month outcomes and 77.8/22.2/50 for 6-month outcomes. The nICP TTP ratio had values of 100/0/56.3 for 1-month and 99.9/42.9/72.2 for 6-month outcomes. The nICP P2/P1 × TTP values were 100/0/56.3 for 1-month outcomes and 81.8/28.6/61.1 for 6-month outcomes. Conclusion Brain4Care’s noninvasive method showed low specificity and accuracy and cannot be used as the sole means of monitoring ICP in patients with severe TBI. Future studies with a larger sample of patients with P2 > P1 and new nICP curve parameters are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-023-05580-z.

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“…In the context of hydrocephalus, for instance, the system has been used to evaluate children with shunt malfunction [32,33]. While further studies are necessary, the system may be considered for the evaluation of nonprimary neurological disorders such as robotic prostatic surgery [34], acute respiratory distress syndrome and end-stage renal disease [35][36][37], as well as a screening method for brain death assessment [38].…”

Section: Noninvasive Icp Monitoringmentioning

confidence: 99%

A Point-of-Care Noninvasive Technique for Surrogate ICP Waveforms Application in Neurocritical Care

2023

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Noninvasive intracranial pressure real-time waveform analysis monitor during prostatectomy robotic surgery and Trendelenburg position: case report

Cited by 5 publications

References 7 publications

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients

Can a new noninvasive method for assessment of intracranial pressure predict intracranial hypertension and prognosis?

A Point-of-Care Noninvasive Technique for Surrogate ICP Waveforms Application in Neurocritical Care

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