• J Clin Monit Comput · Jun 2023

    Clinical Trial

    Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients.

    • Sérgio Brasil, Gustavo Frigieri, Fabio Silvio Taccone, Chiara Robba, SollaDavi Jorge FontouraDJFDivision of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, São Paulo, 05403000, Brazil., Ricardo de Carvalho Nogueira, Marcia Harumy Yoshikawa, Manoel Jacobsen Teixeira, MalbouissonLuiz Marcelo SáLMSDepartment of Intensive Care, School of Medicine, University of São Paulo, São Paulo, Brazil., and Wellingson Silva Paiva.
    • Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, São Paulo, 05403000, Brazil. sbrasil@alumni.usp.br.
    • J Clin Monit Comput. 2023 Jun 1; 37 (3): 753760753-760.

    AbstractAnalysis of intracranial pressure waveforms (ICPW) provides information on intracranial compliance. We aimed to assess the correlation between noninvasive ICPW (NICPW) and invasively measured intracranial pressure (ICP) and to assess the NICPW prognostic value in this population. In this cohort, acute brain-injured (ABI) patients were included within 5 days from admission in six Intensive Care Units. Mean ICP (mICP) values and the P2/P1 ratio derived from NICPW were analyzed and correlated with outcome, which was defined as: (a) early death (ED); survivors on spontaneous breathing (SB) or survivors on mechanical ventilation (MV) at 7 days from inclusion. Intracranial hypertension (IHT) was defined by ICP > 20 mmHg. A total of 72 patients were included (mean age 39, 68% TBI). mICP and P2/P1 values were significantly correlated (r = 0.49, p < 0.001). P2/P1 ratio was significantly higher in patients with IHT and had an area under the receiving operator curve (AUROC) to predict IHT of 0.88 (95% CI 0.78-0.98). mICP and P2/P1 ratio was also significantly higher for ED group (n = 10) than the other groups. The AUROC of P2/P1 to predict ED was 0.71 [95% CI 0.53-0.87], and the threshold P2/P1 > 1.2 showed a sensitivity of 60% [95% CI 31-83%] and a specificity of 69% [95% CI 57-79%]. Similar results were observed when decompressive craniectomy patients were excluded. In this study, P2/P1 derived from noninvasive ICPW assessment was well correlated with IHT. This information seems to be as associated with ABI patients outcomes as ICP.Trial registration: NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219 .© 2022. The Author(s).

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