The non-invasive ICP measurement method based on two-depth TCD technology has a better diagnostic reliability on neurological patients than the ONSD method when expressed by the sensitivity and specificity for detecting elevated ICP >14·7 mmHg.
Measurement of intracranial pressure (ICP) is necessary in many neurological and neurosurgical diseases. To avoid lumbar puncture or intracranial ICP probes, non-invasive ICP techniques are becoming popular. A recently developed technology uses two-depth Doppler to compare arterial pulsations in the intra- and extra-cranial segments of the ophthalmic artery for non-invasive estimation of ICP. The aim of this study was to investigate how well non-invasively-measured ICP and invasively-measured cerebrospinal fluid (CSF) pressure correlate. We performed multiple measurements over a wide ICP span in eighteen elderly patients with communicating hydrocephalus. As a reference, an automatic CSF infusion apparatus was connected to the lumbar space. Ringer's solution was used to create elevation to pre-defined ICP levels. Bench tests of the infusion apparatus showed a random error (95 % CI) of less than ±0.9 mmHg and a systematic error of less than ±0.5 mmHg. Reliable Doppler signals were obtained in 13 (72 %) patients. An infusion test could not be performed in one patient. Thus, twelve patients and a total of 61 paired data points were studied. The correlation between invasive and non-invasive ICP measurements was good (R = 0.74), and the 95 % limits of agreements were -1.4 ± 8.8 mmHg. The within-patient correlation varied between 0.47 and 1.00. This non-invasive technique is promising, and these results encourage further development and evaluation before the method can be recommended for use in clinical practice.
ObjectiveThis study was performed to investigate the correlation among decreased
regional cerebral oxygen saturation (rSO2), blood levels of brain
injury biomarkers, and postoperative cognitive disorder (POCD) after cardiac
surgery with cardiopulmonary bypass (CPB).MethodsThis prospective observational study included 59 patients undergoing coronary
artery bypass graft surgery with CPB. All patients underwent
neuropsychological tests (Mini Mental State Evaluation, Rey Auditory Verbal
Learning Test, digit span test, digit symbol substitution test, and Schulte
table) the day before and 10 days after the surgery. The blood levels of two
brain injury biomarkers, neuron-specific enolase (NSE) and glial fibrillary
acidic protein (GFAP), were measured before and 1 day after the surgery.ResultsThe rSO2 decreased during surgery in 21 (35%) patients. POCD was
detected in 22 (37%) patients. After the surgery, no significant changes in
the GFAP blood level occurred in any patients. No significant correlations
were found among the decreased rSO2, increased NSE blood level,
and rate of POCD.ConclusionThese results suggest that a decrease in rSO2 during cardiac
surgery is not necessarily related to the development of POCD or an
increased blood level of the brain injury biomarker NSE.
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