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Multimodal non-invasive assessment of intracranial hypertension: an observational study

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...

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Autores principales: Robba, Chiara, Pozzebon, Selene, Moro, Bedrana, Vincent, Jean-Louis, Creteur, Jacques, Taccone, Fabio Silvio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318399/
https://www.ncbi.nlm.nih.gov/pubmed/32591024
http://dx.doi.org/10.1186/s13054-020-03105-z
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author Robba, Chiara
Pozzebon, Selene
Moro, Bedrana
Vincent, Jean-Louis
Creteur, Jacques
Taccone, Fabio Silvio
author_facet Robba, Chiara
Pozzebon, Selene
Moro, Bedrana
Vincent, Jean-Louis
Creteur, Jacques
Taccone, Fabio Silvio
author_sort Robba, Chiara
collection PubMed
description 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.
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spelling pubmed-73183992020-06-29 Multimodal non-invasive assessment of intracranial hypertension: an observational study Robba, Chiara Pozzebon, Selene Moro, Bedrana Vincent, Jean-Louis Creteur, Jacques Taccone, Fabio Silvio Crit Care Research 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. BioMed Central 2020-06-26 /pmc/articles/PMC7318399/ /pubmed/32591024 http://dx.doi.org/10.1186/s13054-020-03105-z Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Robba, Chiara
Pozzebon, Selene
Moro, Bedrana
Vincent, Jean-Louis
Creteur, Jacques
Taccone, Fabio Silvio
Multimodal non-invasive assessment of intracranial hypertension: an observational study
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 Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318399/
https://www.ncbi.nlm.nih.gov/pubmed/32591024
http://dx.doi.org/10.1186/s13054-020-03105-z
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