scholarly journals Noninvasive Evaluation of Intracranial Pressure by Transcranial Doppler Ultrasound in Patients With Traumatic Brain Injury

2020 ◽  
Author(s):  
Tao Chang ◽  
Yanlong Yang ◽  
Zhen Qian ◽  
Qingbao Guo ◽  
Lihong Li
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Doppler Ultrasound ◽  
Transcranial Doppler ◽  
Strong Correlation ◽  
Transcranial Doppler Ultrasound ◽  
The Relationship ◽  
Different Levels

Abstract Background As a noninvasive monitoring measure, transcranial Doppler ultrasound (TCD) has been widely used to monitor the secondary brain injury in patients with traumatic brain injury (TBI). There are different physiological theories on the noninvasive assessment of intracranial pressure by TCD parameters, including ONSD and PI, which may cause that the change of ONSD and PI is not always synchronous with that of ICP. Therefore, the objective of this study was to investigate the relationship between PI or ONSD and ICP at different levels or in different periods after the operation, and the ability of prediction intracranial hypertension with these parameters in patients with TBI. Methods The clinical data of 68 patients with TBI were retrospectively analyzed. The statistical correlation analysis was performed to investigate the relationship between the PI or ONSD and ICP one week after the operation. Besides, the area under the curve (AUC) of ONSD or PI alone or a combination of them was calculated to determine the ability of intracranial hypertension. Results 1. There was a correlation between ONSD and ICP ≥ 20 mmHg (r = 0.665, p < 0.001), ICP < 20 mmHg (r = 0.358, p = 0.006). The correlation still remained at ONSD ≥ 5 mm (r = 0.644, p < 0.001), but no correlation at ONSD < 5 mm (p = 0.137). 2. There was a strong correlation between PI and ICP at ICP of 15–20 mmHg (r = 0.705, p < 0.001), and ICP ≥ 20 mmHg (r = 0.716, p < 0.001). Nevertheless, it revealed a weak correlation at PI < 1.2 (r = 0.271, p = 0.021), PI ≥ 1.2 (r = 0.350, p = 0.020). In different period after the operation, there was a moderate correlation between ICP and PI on days 3, 4, and 5 (r = 0.508, p < 0.001), a strong correlation on days 6 and 7 after the operation (r = 0.645, p < 0.001). 3. For prediction intracranial hypertension with PI ≥ 1.2 or ONSD ≥ 5 mm alone or a combination of ONSD ≥ 5 mm and PI ≥ 1.2, the AUC value was 0.729 (p < 0.001), 0.900 (p < 0.001), and 0.943 (p < 0.001), respectively. Conclusion The correlation between the parameters of TCD, including ONSD and PI, and invasive ICP vary at different levels of ICP and in different periods in patients with TBI post-operation. It could also allow for a more accurate prediction of elevated intracranial pressure with a combination of ONSD ≥ 5 mm and PI ≥ 1.2.

scholarly journals Experimental model of intracranial hypertension with continuous multiparametric monitoring in swine

2013 ◽  
Vol 71 (10) ◽  
pp. 802-806 ◽  
Author(s):  
Almir Ferreira de Andrade ◽  
Matheus Schmidt Soares ◽  
Gustavo Cartaxo Patriota ◽  
Alessandro Rodrigo Belon ◽  
Wellingson Silva Paiva ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Animal Model ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Severe Traumatic Brain Injury ◽  
Transcranial Doppler ◽  
Porcine Model ◽  
Cerebral Oximetry ◽  
Suitable Animal Model

Objective Intracranial hypertension (IH) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, IH was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.

scholarly journals The Relationship of Triphasic Waves with Intracranial Pressure as a Possible Prognostic Marker in Traumatic Brain Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Nakul Katyal ◽  
Aarti Sarwal ◽  
Pravin George ◽  
Biswajit Banik ◽  
Christopher R. Newey
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Prognostic Marker ◽  
Prognostic Significance ◽  
Nonconvulsive Seizures ◽  
Severe Tbi ◽  
Relationship Of ◽  
The Relationship

Background.Continuous electroencephalography (CEEG) monitoring is used for detection of convulsive and nonconvulsive seizures and assessing the degree of encephalopathy in critically ill patients. A commonly seen encephalopathic pattern on CEEG is generalized periodic discharges with triphasic wave (TW) morphology. The underlying role and prognostic significance of TW in relationship to intracranial pressure (ICP) remain unknown. We present a case highlighting the relationship of TW with ICP in a case with severe traumatic brain injury (TBI).Method.Case report.Results.A patient with severe TBI and no underlying metabolic abnormalities was admitted to the neurocritical care unit. TW were seen on CEEG. The TW diminished during episodes of intracranial hypertension but reappeared with reduction of the intracranial pressure.Conclusion.This study highlights a possible favorable prognostic marker of finding TW in a patient with intracranial hypertension. We have proposed a preliminary understanding of the relationship between TW and intracranial hypertension, which may be helpful in formulating future studies involving larger cohorts.

scholarly journals Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jia-cheng Gu ◽  
Hong Wu ◽  
Xing-zhao Chen ◽  
Jun-feng Feng ◽  
Guo-yi Gao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
External Ventricular Drainage ◽  
Unfavorable Outcome ◽  
Ventricular Drainage ◽  
Outcome Group ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

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