Danilo Cardim1, Chiara Robba2,3, Marek Czosnyka4, Davide Savo5, Aurelién Mazeraud5,6, Carolina Iaquaniello7, Erika Banzato7, Paola Rebora7, Giuseppe Citerio5,7. 1. Brain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge. 2. Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals Trust. 3. Anesthesia and Intensive Care, San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova. 4. Brain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. 5. Neurointensive Care Unit, San Gerardo Hospital, Monza. 6. Neurointensive Care, Centre Hospitalier Sainte-Anne, Paris Descartes University, Paris, France. 7. School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
Abstract
BACKGROUND: Transcranial Doppler (TCD) ultrasonography has been described for the noninvasive assessment of intracranial pressure (ICP). This study investigates the relationship between standard, invasive intracranial pressure monitoring (ICPi) and noninvasive ICP assessment using a simple formula based on TCD-derived flow velocity (FV) and mean arterial blood pressure values (ICPTCD). MATERIAL AND METHODS: We performed a prospective observational study on 100 consecutive traumatic brain injury patients requiring invasive ICP monitoring, admitted to the Neurosciences and Trauma Critical Care Unit of Addenbrooke's Hospital, Cambridge, UK. ICPi was compared with ICPTCD using a method based on the "diastolic velocity-derived estimator" (FVd), which was initially described for the noninvasive estimation of cerebral perfusion pressure but subsequently utilized for ICP assessment. RESULTS: Median ICPi was 13 mm Hg (interquartile range: 10, 17.25 mm Hg). There was no correlation between ICPi and ICPTCD (R=-0.17; 95% confidence interval [CI]: -0.35, 0.03; P=0.097). Bland-Altman analysis demonstrated wide 95% limits of agreement between ICPi and ICPTCD (-27.58, 30.10; SD, 14.42). ICPTCD was not able to detect intracranial hypertension (ICPi >20 mm Hg); the area under the receiver operating characteristic curve for prediction was 34.5% (95% CI, 23.1%-45.9%) with 0% sensitivity and 74.4% specificity for ICPTCD to detect ICPi>20 mm Hg. CONCLUSIONS: Using a formula based on diastolic FV, TCD is an insufficiently accurate method for the noninvasive assessment of ICP. Further studies are warranted to confirm these results in a broader patient cohort.
BACKGROUND: Transcranial Doppler (TCD) ultrasonography has been described for the noninvasive assessment of intracranial pressure (ICP). This study investigates the relationship between standard, invasive intracranial pressure monitoring (ICPi) and noninvasive ICP assessment using a simple formula based on TCD-derived flow velocity (FV) and mean arterial blood pressure values (ICPTCD). MATERIAL AND METHODS: We performed a prospective observational study on 100 consecutive traumatic brain injurypatients requiring invasive ICP monitoring, admitted to the Neurosciences and Trauma Critical Care Unit of Addenbrooke's Hospital, Cambridge, UK. ICPi was compared with ICPTCD using a method based on the "diastolic velocity-derived estimator" (FVd), which was initially described for the noninvasive estimation of cerebral perfusion pressure but subsequently utilized for ICP assessment. RESULTS: Median ICPi was 13 mm Hg (interquartile range: 10, 17.25 mm Hg). There was no correlation between ICPi and ICPTCD (R=-0.17; 95% confidence interval [CI]: -0.35, 0.03; P=0.097). Bland-Altman analysis demonstrated wide 95% limits of agreement between ICPi and ICPTCD (-27.58, 30.10; SD, 14.42). ICPTCD was not able to detect intracranial hypertension (ICPi >20 mm Hg); the area under the receiver operating characteristic curve for prediction was 34.5% (95% CI, 23.1%-45.9%) with 0% sensitivity and 74.4% specificity for ICPTCD to detect ICPi>20 mm Hg. CONCLUSIONS: Using a formula based on diastolic FV, TCD is an insufficiently accurate method for the noninvasive assessment of ICP. Further studies are warranted to confirm these results in a broader patient cohort.
Authors: Denise Battaglini; Lavienraj Premraj; Samuel Huth; Jonathon Fanning; Glenn Whitman; Rakesh C Arora; Judith Bellapart; Diego Bastos Porto; Fabio Silvio Taccone; Jacky Y Suen; Gianluigi Li Bassi; John F Fraser; Rafael Badenes; Sung-Min Cho; Chiara Robba Journal: Front Neurol Date: 2022-04-14 Impact factor: 4.086
Authors: Frank A Rasulo; Stefano Calza; Chiara Robba; Fabio Silvio Taccone; Daniele G Biasucci; Rafael Badenes; Simone Piva; Davide Savo; Giuseppe Citerio; Jamil R Dibu; Francesco Curto; Martina Merciadri; Paolo Gritti; Paola Fassini; Soojin Park; Massimo Lamperti; Pierre Bouzat; Paolo Malacarne; Arturo Chieregato; Rita Bertuetti; Raffaele Aspide; Alfredo Cantoni; Victoria McCredie; Lucrezia Guadrini; Nicola Latronico Journal: Crit Care Date: 2022-04-15 Impact factor: 9.097