A clinical comparison of subdural screw pressure measurements with ventricular pressure

Ad, Mendelow; Jo, Rowan; Murray, Lauren; Ae, Kerr

doi:10.3171/jns.1983.58.1.0045

Cited by 77 publications

(13 citation statements)

References 13 publications

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“…Simultaneous measurements of ICP by a parenchymal probe and an epidural probe have shown a bias of 4.3 mmHg, with an associated SDE of 8.5 mmHg (35). Subdural screws are deemed unreliable because of their relatively poor accuracy and tendency to underestimate high ICP, with median differences greater than 10 mmHg in 40–60% of comparisons against the ventricular catheter (36). …”

Section: Discussionmentioning

confidence: 99%

Model-Based Noninvasive Estimation of Intracranial Pressure from Cerebral Blood Flow Velocity and Arterial Pressure

et al. 2012

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Intracranial pressure (ICP) is affected in many neurological conditions. Clinical measurement of pressure on the brain currently requires placing a probe in the cerebrospinal fluid compartment, the brain tissue, or other intracranial space. This invasiveness limits the measurement to critically ill patients. As ICP is also clinically important in conditions ranging from brain tumors and hydrocephalus to concussions, noninvasive determination of ICP would be desirable. Our model-based approach to continuous estimation and tracking of ICP uses routinely obtainable time-synchronized, noninvasive (or minimally invasive) measurements of peripheral arterial blood pressure and blood flow velocity in the middle cerebral artery (MCA), both at intra-heartbeat resolution. A physiological model of cerebrovascular dynamics provides mathematical constraints that relate the measured waveforms to ICP. Our algorithm produced patient-specific ICP estimates with no calibration or training. Using 35 hours of data from 37 patients with traumatic brain injury, we generated ICP estimates on 2,665 non-overlapping 60-beat data windows. Referenced against concurrently recorded invasive parenchymal ICP that varied over 100 mmHg across all records, our estimates achieved a mean error (bias) of 1.6 mmHg and standard deviation of error (SDE) of 7.6 mmHg. For the 1,673 data windows over 22 hours in which blood flow velocity recordings were available from both the left and right MCA, averaging the resulting bilateral ICP estimates reduced the bias to 1.5 mmHg and SDE to 5.9 mmHg. This accuracy is already comparable to that of some invasive ICP measurement methods in current clinical use.

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Section: Discussionmentioning

confidence: 99%

Model-Based Noninvasive Estimation of Intracranial Pressure from Cerebral Blood Flow Velocity and Arterial Pressure

et al. 2012

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“…A implantação de cateteres subaracnóideos à beira do leito não constituiu fator de risco adicional para complicações infecciosas, como já observado por Yano e col 10 . O parafuso metálico de aço inoxidável foi utilizado nos primeiros 11 pacientes e mostrou alguns inconvenientes como uma tendência de "achatamento" da curva de PIC, principalmente em níveis mais elevados, com necessidade de algumas irrigações do sistema, com aumento dos riscos de contaminação do sistema e descompensão da PIC [11][12][13] . Inconvenientes adicionais observados com o uso do parafuso foram o seu alto perfil, que dificultou a mobilização dos pacientes, além do aparecimento de artefatos metálicos indesejáveis na TC de controle 14,15 .…”

Section: Discussionunclassified

Aspectos técnicos da monitorização da pressão intracraniana pelo método subaracnóideo no traumatismo craniencefálico grave

Filho

Falcão

Sardinha

et al. 2001

Arq. Neuro-Psiquiatr.

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RESUMO -Foram analisados prospectivamente 206 pacientes com traumatismo craniencefálico (TCE) grave (8 pontos ou menos na Escala de Coma de Glasgow), internados na Unidade de Terapia Intensiva do Hospital das Clínicas da Universidade Estadual de Campinas. Após avaliação por tomografia computadorizada de crânio (TC), 72 pacientes necessitaram de tratamento neurocirúrgico. Todos os pacientes foram submetidos à monitorização contínua da pressão intracraniana (PIC) pelo método subaracnóideo (11 com parafuso metálico e 195 com cateter plástico). Os níveis de PIC foram registrados continuamente na tela do monitor, sendo os seus valores de final de hora anotados em ficha padronizada. Todos os pacientes foram tratados segundo um protocolo orientado pelos níveis da PIC. Não foram observadas complicações hemorrágicas ou hematomas intracranianos relacionados ao método de monitorização em TC de controle. Para controle de infecções intracranianas, foram colhidas amostras de líquido cefalorraquidiano através de punção lateral C1-C2 em 66 pacientes com PIC abaixo de 20 mm Hg, sendo positivas as culturas para Acinetobacter sp em 2 pacientes. O resultado final na alta hospitalar mostrou 75 (36,40%) óbitos e 131 (63,6%) sobreviventes. Os níveis de PIC influenciaram significativamente o resultado final (p<0,001), o que confirma a importância de sua monitorização e controle no tratamento do TCE grave. O método subaracnóideo para a monitorização contínua da PIC foi considerado aplicável, seguro, simples, de baixo custo e útil para a orientação do tratamento. A metodologia de registro da PIC foi considerada útil e prática. Apesar dos avanços técnicos nesta área, o método subaracnóideo mostrou-se uma alternativa bastante viável para a monitorização da PIC em pacientes com traumatismo craniencefálico grave. PALAVRAS-CHAVE: traumatismo craniencefálico, pressão intracraniana, escala de coma de Glasgow, coma. Technical aspects of intracranial pressure monitoring by subarachnoid method in severe head injuryABSTRACT -Two hundred and six patients with severe head injury (Glasgow Coma Scale of 8 points or less after nonsurgical resuscitation on admission), managed at Intensive Care Unit-Hospital das Clínicas -Universidade Estadual de Campinas were prospectively analysed. All patients were assessed by CT scan and 72 required neurosurgical intervention. All patients were continuously monitored to evaluate intracranial pressure (ICP) levels by a subarachnoid device (11 with subarachnoid metallic bolts and 195 with subarachnoid polyvinyl catheters). The ICP levels were continuously observed in the bedside pressure monitor display and their endhour values were recorded in a standard chart. The patients were managed according to a standard protocol guided by the ICP levels. There were no intracranial haemorrhagic complications or hematomas due the monitoring method. Sixty six patients were punctured by lateral C1-C2 technique to assess infectious complications and 2 had positive cerebrospinal fluid samples for Acinetobacter sp. The final results me...

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“…A better definition would be bacterial colonization of the device rather than infection, as there have been no reports in large prospective studies of clinically significant intracranial infections associated with ICP monitoring devices. [16][17][18][19] Colonization of the ICP devices increases significantly after 5 days of implantation16-23 and, when detected, is treated by removal of the device. Irrigation of fluid coupled ICP devices significantly increases bacterial colonization,16 leading, in one study,2 to an increase from 6% to 19% (the higher rate was excluded in the subsequent analysis of ICP device complications).…”

Section: Scientific Foundationmentioning

confidence: 99%

Recommendations for Intracranial Pressure Monitoring Technology

1996

Journal of Neurotrauma

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A clinical comparison of subdural screw pressure measurements with ventricular pressure

Cited by 77 publications

References 13 publications

Model-Based Noninvasive Estimation of Intracranial Pressure from Cerebral Blood Flow Velocity and Arterial Pressure

Model-Based Noninvasive Estimation of Intracranial Pressure from Cerebral Blood Flow Velocity and Arterial Pressure

Aspectos técnicos da monitorização da pressão intracraniana pelo método subaracnóideo no traumatismo craniencefálico grave

Recommendations for Intracranial Pressure Monitoring Technology

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