Multimodal non-invasive assessment of intracranial hypertension: an observational study.
Brain injury
Neuro-ICU
Non-invasive intracranial pressure
Optic nerve sheath diameter
Pupillometer
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
26 06 2020
26 06 2020
Historique:
received:
20
03
2020
accepted:
17
06
2020
entrez:
28
6
2020
pubmed:
28
6
2020
medline:
26
3
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32591024
doi: 10.1186/s13054-020-03105-z
pii: 10.1186/s13054-020-03105-z
pmc: PMC7318399
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
379Références
J Neurosci Res. 2018 Apr;96(4):720-730
pubmed: 28880397
Surg Neurol Int. 2011;2:82
pubmed: 21748035
Intensive Care Med. 2007 Oct;33(10):1704-11
pubmed: 17668184
Intensive Care Med. 2015 Jan;41(1):177
pubmed: 25403757
Crit Care. 2017 Feb 27;21(1):44
pubmed: 28241847
Acta Neurochir (Wien). 2008 Mar;150(3):209-14; discussion 214
pubmed: 18278575
Neurocrit Care. 2012 Aug;17(1):58-66
pubmed: 22311229
Intensive Care Med. 2018 Aug;44(8):1284-1294
pubmed: 30019201
Crit Care. 2016 Mar 13;20:99
pubmed: 27072310
J Neurol Neurosurg Psychiatry. 2001 Feb;70(2):198-204
pubmed: 11160468
Intensive Care Med. 2018 Dec;44(12):2102-2111
pubmed: 30478620
J Neurosurg Anesthesiol. 2019 Jul 12;:
pubmed: 31306262
Front Neurol. 2014 Jul 16;5:121
pubmed: 25076934
Resuscitation. 2019 Apr;137:221-228
pubmed: 30629992
J Neurotrauma. 1992 Mar;9 Suppl 1:S287-92
pubmed: 1588618
J Neurotrauma. 2016 Apr 15;33(8):792-802
pubmed: 26414916
Neurocrit Care. 2006;4(1):8-13
pubmed: 16498188
J Neurosurg. 2003 Jan;98(1):205-13
pubmed: 12546375
Intensive Care Med. 2019 Dec;45(12):1783-1794
pubmed: 31659383
Crit Care. 2019 May 2;23(1):155
pubmed: 31046817
Crit Care Med. 2012 Jun;40(6):1914-22
pubmed: 22488001
Crit Care. 2008;12(5):R114
pubmed: 18786243
Curr Neurol Neurosci Rep. 2018 Oct 2;18(12):82
pubmed: 30280261
Surg Neurol. 2004 Jul;62(1):45-51; discussion 51
pubmed: 15226070
Crit Care. 2017 Sep 6;21(1):233
pubmed: 28874206
J Neurosurg. 1998 May;88(5):802-8
pubmed: 9576246
N Engl J Med. 2012 Dec 27;367(26):2471-81
pubmed: 23234472
Acta Neurol Scand. 2016 Jul;134(1):4-21
pubmed: 26515159
Neurocrit Care. 2015 Dec;23(3):419-26
pubmed: 26268137
Curr Opin Crit Care. 2017 Apr;23(2):110-114
pubmed: 28157822
Dev Med Child Neurol. 2011 Mar;53(3):281-4
pubmed: 20875043
BMJ. 2019 Jul 24;366:l4225
pubmed: 31340932
PLoS Med. 2017 Jul 25;14(7):e1002356
pubmed: 28742869
J Neurosurg. 2019 Mar 8;:1-7
pubmed: 30849751
J Neurosurg Anesthesiol. 2017 Jul;29(3):243-250
pubmed: 26998650
Neurosurgery. 1980 Jan;6(1):1-9
pubmed: 7354892
Br J Anaesth. 2016 Dec;117(6):783-791
pubmed: 27956677
Transplant Proc. 2015 Nov;47(9):2647-9
pubmed: 26680061
Intensive Care Med. 2019 Jul;45(7):913-927
pubmed: 31025061
Neurocrit Care. 2016 Dec;25(3):473-491
pubmed: 26940914
Acta Neurochir (Wien). 2014 Aug;156(8):1615-22
pubmed: 24849391