BackgroundIntracranial pressure (ICP) values guide treatment and diagnosis in the ICU. Lack of agreement on ICP determination reduces the validity of ICP as a predictor variable in research and clinical practice. This study explores international perspectives of interpreting an ICP tracing to document an ICP value across varying lengths of time.MethodsThis was a prospective anonymous online survey study of clinician practice of ICP measurement using patient data showing an ICP trend. Participants were shown one of three scenarios at 1-minute, 3-minute, and 5-minute ICP trends. It wasn't possible to randomized participants, however multiple reading improves precision. Paired t-test was used to explore for differences within each scenario and between each epoch.ResultsThere were a total of 332 international responses which came from 247 nurses, 43 attending physicians, 29 nurse practitioners, and 12 physicians in training. Estimates of ICP were significantly different for two of the three scenarios (p < .0001). The range of ICP values was largest during the 3-minute epoch (from 5 to 40 mmHg).ConclusionsThere is a wide and inconsistent variation in the determination of ICP with significant difference between for two of the three scenarios. Without a standardized amount of time to provide to clinicians, variability in ICP reporting will continue.
BACKGROUND:The Bispectral (BIS) monitor is a validated, noninvasive monitor placed over the forehead to titrate sedation in patients under general anesthesia in the operating room. In the neurocritical care unit, there is limited room on the forehead because of incisions, injuries, and other monitoring devices. This is a pilot study to determine whether a BIS nasal montage correlates to the standard frontal-temporal data in this patient population. METHODS: This prospective nonandomized pilot study enrolled 10 critically ill, intubated, and sedated adult patients admitted to the neurocritical care unit. Each patient had a BIS monitor placed over the standard frontal-temporal location and over the alternative nasal dorsum with simultaneous data collected for 24 hours. RESULTS: In the frontal-temporal location, the mean (SD) BIS score was 50.9 (15.0), average minimum BIS score was 47.0 (15.0), and average maximum BIS score was 58.4 (16.7). In the nasal dorsum location, the mean BIS score was 54.8 (21.6), average minimum BIS score was 52.8 (20.9), and average maximum BIS score was 58.0 (22.2). Baseline nonparametric tests showed nonsignificant P values for all variables except for Signal Quality Index. Generalized linear model analysis demonstrated significant differences between the 2 monitor locations ( P < .0001). CONCLUSION: The results of this pilot study do not support using a BIS nasal montage as an alternative for patients in the neurocritical care unit.
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