Brain Skull Deformation as a Non-invasive Intracranial Pressure (ICP) Measure

Federal University of São Paulo18 enrolled

Overview

Background: Although placement of an intra-cerebral catheter remains the gold standard method for measuring intracranial pressure (ICP), there are several limitations to the method. Objectives: The main objective of this study was to compare the correlation and the agreement of the wave morphology between the ICP (standard ICP monitoring) and a new nICP monitor in patients admitted with stroke. Our secondary objective was to estimate the accuracy of four non-invasive methods to assess intracranial hypertension. Methods: We prospectively collected data of adults admitted to an intensive care unit (ICU) with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) or ischemic stroke (IS) in whom invasive ICP monitoring placed. Measures had been simultaneously collected from the following non-invasive indices: optic nerve sheath diameter (ONSD), pulsatility index (PI) using transcranial Doppler (TCD), a 5-point visual scale designed for Computed Tomography (CT) and two parameters (time-to-peak \[TTP\] and P2/P1 ratio) of a non-invasive ICP wave morphology monitor (Brain4care\[B4c\]). Intracranial hypertension was defined as an invasively measured ICP \> 20 mmHg for at least five minutes.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Subarachnoid Hemorrhage Stroke Stroke, Ischemic Stroke Hemorrhagic Intracranial Hypertension

Interventions

ICP wave morphology comparison between a non-invasive (Brain4care) and a invasive methodDEVICE

We prospectively collected data of adults admitted to an intensive care unit (ICU) with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) or ischemic stroke (IS) in whom invasive ICP monitoring placed. Measures had been simultaneously collected from the following non-invasive indices: optic nerve sheath diameter (ONSD), pulsatility index (PI) using transcranial Doppler (TCD), a 5-point visual scale designed for Computed Tomography (CT) and two parameters (time-to-peak \[TTP\] and P2/P1 ratio) of a non-invasive ICP wave morphology monitor (Brain4care\[B4c\]). Intracranial hypertension was defined as an invasively measured ICP \> 20 mmHg for at least five minutes

Outcomes

Primary Outcomes

Comparison between ICP morphology between a non invasive (Brain4care [B4c]) and a invasive (intraventricular) method

Parameter of the ICP wave between methods were compared (P2/P1 ratio)

Time frame: At least 30 minutes for every patient

Comparison between ICP morphology between a non invasive (Brain4care [B4c]) and a invasive (intraventricular) method

Parameter of the ICP wave between methods were compared (Time-to-Peak)

Time frame: At least 30 minutes for every patient

Secondary Outcomes

Estimation of Intracranial Hypertension using Transcranial Doppler

We measured the Pulsatility Index using transcranial Doppler (TCD) and calculated a ROC curve to calculate its discriminatory power