The Use of Noninvasive Multimodal Neuromonitoring in Adult Critically Ill Patients With COVID-19 Infection

Battaglini, Denise; Premraj, Lavienraj; Huth, Samuel; Fanning, Jonathon P.; Whitman, Glenn; Arora, Rakesh C.; Bellapart, Judith; Porto, Diego Bastos; Taccone, Fabio Silvio; Suen, Jacky Y.; Bassi, Gianluigi Li; Fraser, John F.; Cho, Sung Min; Robba, Chiara

doi:10.1097/ana.0000000000000859

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…Previously published studies have addressed the issue of neurosonological findings in critically ill patients with COVID-19 and their clinical outcomes (40)(41)(42); our study, in addition to describing the neurosonological findings, studied the association of hemodynamic and ventilatory parameters with neurosonological findings and mortality. Recording ventilatory mechanics to interpret the results is essential because intrathoracic pressures are very high and the lungs are very damaged, this could cause a decrease in cerebral venous return and increase ICP, therefore, reliable conclusions cannot be obtained without analyzing the relationship between these variables.…”

Section: Discussionmentioning

confidence: 99%

Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru

Heredia-Orbegoso,

Vences,

Failoc-Rojas

et al. 2024

Front. Neurol.

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AimWe aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru.MethodsWe included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance.ResultsThis study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15).ConclusionsA high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.

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Section: Discussionmentioning

confidence: 99%

Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru

Heredia-Orbegoso,

Vences,

Failoc-Rojas

et al. 2024

Front. Neurol.

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“…Noninvasive monitoring may aid the neurological evaluation and the implementation of neuroprotective measures in critically ill patients. Alterations in cerebral haemodynamics, brain compliance, brain oxygenation, pupillary response, and brain electrophysiological activity are common in patients with COVID-19 admitted to the ICU [38]. However, these abnormalities are not clearly associated with worse outcome or the development of new neurological complications.…”

Section: Noninvasive Multimodal Neuromonitoringmentioning

confidence: 99%

Neurological complications of critically ill COVID-19 patients

Sonneville

Dangayach

Newcombe

2023

Current Opinion in Critical Care

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Purpose of review COVID-19 and systemic critical illness are both associated with neurological complications. We provide an update on the diagnosis and critical care management of adult patients with neurological complications of COVID-19. Recent findingsLarge prospective multicentre studies conducted in the adult population over the last 18 months improved current knowledge on severe neurological complications of COVID-19. In COVID-19 patients presenting with neurological symptoms, a multimodal diagnostic workup (including CSF analysis, brain MRI, and EEG) may identify different syndromes associated with distinct trajectories and outcomes. Acute encephalopathy, which represents the most common neurological presentation of COVID-19, is associated with hypoxemia, toxic/metabolic derangements, and systemic inflammation. Other less frequent complications include cerebrovascular events, acute inflammatory syndromes, and seizures, which may be linked to more complex pathophysiological processes. Neuroimaging findings include infarction, haemorrhagic stroke, encephalitis, microhaemorrhages and leukoencephalopathy. In the absence of structural brain injury, prolonged unconsciousness is usually fully reversible, warranting a cautious approach for prognostication. Advanced quantitative MRI may provide useful insights into the extent and pathophysiology of the consequences of COVID-19 infection including atrophy and functional imaging changes in the chronic phase. SummaryOur review highlights the importance of a multimodal approach for the accurate diagnosis and management of complications of COVID-19, both at the acute phase and in the long-term.

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“…NIRS has been evaluated to assess cerebral perfusion and autoregulation after cardiac arrest and detect episodes of cerebral desaturation showing a correlation between its values and severity of illness and with variable association between rSO 2 value and outcome [41,42]. Similarly, NIRS has shown to be useful to assess episodes of cerebral desaturation in patients with acute distress respiratory syndrome and COVID-19 during respiratory manipulations and the use of respiratory rescue therapies [7,[43][44][45][46], as well as in septic patients where cerebral desaturations were found to be predictors of neurological sequelae [47,48].…”

Section: Emergency Department and Intensive Care Unitmentioning

confidence: 99%

The importance of monitoring cerebral oxygenation in non brain injured patients

Robba

Battaglini

Rasulo

et al. 2023

J Clin Monit Comput

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Over the past few years, the use of non-invasive neuromonitoring in non-brain injured patients has increased, as a result of the recognition that many of these patients are at risk of brain injury in a wide number of clinical scenarios and therefore may benefit from its application which allows interventions to prevent injury and improve outcome. Among these, are post cardiac arrest syndrome, sepsis, liver failure, acute respiratory failure, and the perioperative settings where in the absence of a primary brain injury, certain groups of patients have high risk of neurological complications. While there are many neuromonitoring modalities utilized in brain injured patients, the majority of those are either invasive such as intracranial pressure monitoring, require special skill such as transcranial Doppler ultrasonography, or intermittent such as pupillometry and therefore unable to provide continuous monitoring. Cerebral oximetry using Near infrared Spectroscopy, is a simple non invasive continuous measure of cerebral oxygenation that has been shown to be useful in preventing cerebral hypoxemia both within the intensive care unit and the perioperative settings. At present, current recommendations for standard monitoring during anesthesia or in the general intensive care concentrate mainly on hemodynamic and respiratory monitoring without specific indications regarding the brain, and in particular, brain oximetry. The aim of this manuscript is to provide an up-to-date overview of the pathophysiology and applications of cerebral oxygenation in non brain injured patients as part of non-invasive multimodal neuromonitoring in the early identification and treatment of neurological complications in this population.

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The Use of Noninvasive Multimodal Neuromonitoring in Adult Critically Ill Patients With COVID-19 Infection

Cited by 8 publications

References 21 publications

Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru

Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru

Neurological complications of critically ill COVID-19 patients

The importance of monitoring cerebral oxygenation in non brain injured patients

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