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

Rasulo, Frank; Calza, Stefano; Robba, Chiara; Taccone, Fabio Silvio; Biasucci, Daniele Guerino; Badenes, Rafael; Piva, Simone; Savo, Davide; Citerio, Giuseppe; Dibu, Jamil; Curto, Francesco Lo; Merciadri, Martina; Gritti, Paolo; Fassini, Paola; Park, Soo‐Jin; Lamperti, Massimo; Bouzat, Pierre; Malacarne, P; Chieregato, Arturo; Bertuetti, Rita; Aspide, Raffaele; Cantoni, A; McCredie, Victoria; Guadrini, Lucrezia; Latronico, Nicola

doi:10.2139/ssrn.3965381

Cited by 1 publication

(1 citation statement)

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“…Subsequent investigations using these non-invasive methods in different populations has produced mixed results with evidence of good correlation, though less accurate prediction, of absolute nICP and nCPP values (167,168). The multicenter IMPRESSIT-2 study found nICP estimation based on nICP_FVd resulted in a high NPV for ICP >20 mmHg and >25 mmHg, 91.3 and 98.6%, respectively, though a concordance correlation between nICP and invasive ICP of only 33.3% (169). Conversely, in a recent study involving 100 TBI patients, nICP_FVd had essentially no agreement with invasive ICP (R = −0.17; 95% CI: −0.35, 0.03; p = 0.097) and a sensitivity of 0% for detecting ICP >20 mmHg, though notably few patients had elevations in ICP in this cohort (170).…”

Section: Non-invasive Icp and Cppmentioning

confidence: 99%

Multimodal and autoregulation monitoring in the neurointensive care unit

2023

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Given the complexity of cerebral pathology in patients with acute brain injury, various neuromonitoring strategies have been developed to better appreciate physiologic relationships and potentially harmful derangements. There is ample evidence that bundling several neuromonitoring devices, termed “multimodal monitoring,” is more beneficial compared to monitoring individual parameters as each may capture different and complementary aspects of cerebral physiology to provide a comprehensive picture that can help guide management. Furthermore, each modality has specific strengths and limitations that depend largely on spatiotemporal characteristics and complexity of the signal acquired. In this review we focus on the common clinical neuromonitoring techniques including intracranial pressure, brain tissue oxygenation, transcranial doppler and near-infrared spectroscopy with a focus on how each modality can also provide useful information about cerebral autoregulation capacity. Finally, we discuss the current evidence in using these modalities to support clinical decision making as well as potential insights into the future of advanced cerebral homeostatic assessments including neurovascular coupling.

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