Multimodal non-invasive assessment of intracranial hypertension: an observational study
Abstract Background Although placement of an intra-cerebral catheter remains the gold standard method for measuring intracranial pressure (ICP), several non-invasive techniques can provide useful estimates. The aim of this study was to compare the accuracy of four non-invasive methods to assess intr...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-020-03105-z |
| _version_ | 1818153499334017024 |
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| author | Chiara Robba Selene Pozzebon Bedrana Moro Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone |
| author_facet | Chiara Robba Selene Pozzebon Bedrana Moro Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone |
| author_sort | Chiara Robba |
| collection | DOAJ |
| description | Abstract Background Although placement of an intra-cerebral catheter remains the gold standard method for measuring intracranial pressure (ICP), several non-invasive techniques can provide useful estimates. The aim of this study was to compare the accuracy of four non-invasive methods to assess intracranial hypertension. Methods We reviewed prospectively collected data on adult intensive care unit (ICU) patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH) in whom invasive ICP monitoring had been initiated and estimates had been simultaneously collected from the following non-invasive indices: optic nerve sheath diameter (ONSD), pulsatility index (PI), estimated ICP (eICP) using transcranial Doppler, and the neurological pupil index (NPI) measured using automated pupillometry. Intracranial hypertension was defined as an invasively measured ICP > 20 mmHg. Results We studied 100 patients (TBI = 30; SAH = 47; ICH = 23) with a median age of 52 years. The median invasively measured ICP was 17 [12–25] mmHg and intracranial hypertension was present in 37 patients. Median values from the non-invasive techniques were ONSD 5.2 [4.8–5.8] mm, PI 1.1 [0.9–1.4], eICP 21 [14–29] mmHg, and NPI 4.2 [3.8–4.6]. There was a significant correlation between all the non-invasive techniques and invasive ICP (ONSD, r = 0.54; PI, r = 0.50; eICP, r = 0.61; NPI, r = − 0.41—p < 0.001 for all). The area under the curve (AUC) to estimate intracranial hypertension was 0.78 [CIs = 0.68–0.88] for ONSD, 0.85 [95% CIs 0.77–0.93] for PI, 0.86 [95% CIs 0.77–0.93] for eICP, and 0.71 [95% CIs 0.60–0.82] for NPI. When the various techniques were combined, the highest AUC (0.91 [0.84–0.97]) was obtained with the combination of ONSD with eICP. Conclusions Non-invasive techniques are correlated with ICP and have an acceptable accuracy to estimate intracranial hypertension. The multimodal combination of ONSD and eICP may increase the accuracy to estimate the occurrence of intracranial hypertension. |
| first_indexed | 2024-12-11T14:11:35Z |
| format | Article |
| id | doaj.art-9c999e4a43bc4201beb6bec2c24c2f0f |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-11T14:11:35Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-9c999e4a43bc4201beb6bec2c24c2f0f2022-12-22T01:03:25ZengBMCCritical Care1364-85352020-06-0124111010.1186/s13054-020-03105-zMultimodal non-invasive assessment of intracranial hypertension: an observational studyChiara Robba0Selene Pozzebon1Bedrana Moro2Jean-Louis Vincent3Jacques Creteur4Fabio Silvio Taccone5Policlinico San Martino, IRCCS For Oncology and Neuroscience, Department of Integrated Surgical and Diagnostic Science, University of GenovaDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de BruxellesDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de BruxellesDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de BruxellesDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de BruxellesDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de BruxellesAbstract Background Although placement of an intra-cerebral catheter remains the gold standard method for measuring intracranial pressure (ICP), several non-invasive techniques can provide useful estimates. The aim of this study was to compare the accuracy of four non-invasive methods to assess intracranial hypertension. Methods We reviewed prospectively collected data on adult intensive care unit (ICU) patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH) in whom invasive ICP monitoring had been initiated and estimates had been simultaneously collected from the following non-invasive indices: optic nerve sheath diameter (ONSD), pulsatility index (PI), estimated ICP (eICP) using transcranial Doppler, and the neurological pupil index (NPI) measured using automated pupillometry. Intracranial hypertension was defined as an invasively measured ICP > 20 mmHg. Results We studied 100 patients (TBI = 30; SAH = 47; ICH = 23) with a median age of 52 years. The median invasively measured ICP was 17 [12–25] mmHg and intracranial hypertension was present in 37 patients. Median values from the non-invasive techniques were ONSD 5.2 [4.8–5.8] mm, PI 1.1 [0.9–1.4], eICP 21 [14–29] mmHg, and NPI 4.2 [3.8–4.6]. There was a significant correlation between all the non-invasive techniques and invasive ICP (ONSD, r = 0.54; PI, r = 0.50; eICP, r = 0.61; NPI, r = − 0.41—p < 0.001 for all). The area under the curve (AUC) to estimate intracranial hypertension was 0.78 [CIs = 0.68–0.88] for ONSD, 0.85 [95% CIs 0.77–0.93] for PI, 0.86 [95% CIs 0.77–0.93] for eICP, and 0.71 [95% CIs 0.60–0.82] for NPI. When the various techniques were combined, the highest AUC (0.91 [0.84–0.97]) was obtained with the combination of ONSD with eICP. Conclusions Non-invasive techniques are correlated with ICP and have an acceptable accuracy to estimate intracranial hypertension. The multimodal combination of ONSD and eICP may increase the accuracy to estimate the occurrence of intracranial hypertension.http://link.springer.com/article/10.1186/s13054-020-03105-zNeuro-ICUNon-invasive intracranial pressureBrain injuryPupillometerOptic nerve sheath diameter |
| spellingShingle | Chiara Robba Selene Pozzebon Bedrana Moro Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone Multimodal non-invasive assessment of intracranial hypertension: an observational study Critical Care Neuro-ICU Non-invasive intracranial pressure Brain injury Pupillometer Optic nerve sheath diameter |
| title | Multimodal non-invasive assessment of intracranial hypertension: an observational study |
| title_full | Multimodal non-invasive assessment of intracranial hypertension: an observational study |
| title_fullStr | Multimodal non-invasive assessment of intracranial hypertension: an observational study |
| title_full_unstemmed | Multimodal non-invasive assessment of intracranial hypertension: an observational study |
| title_short | Multimodal non-invasive assessment of intracranial hypertension: an observational study |
| title_sort | multimodal non invasive assessment of intracranial hypertension an observational study |
| topic | Neuro-ICU Non-invasive intracranial pressure Brain injury Pupillometer Optic nerve sheath diameter |
| url | http://link.springer.com/article/10.1186/s13054-020-03105-z |
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