A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest

Abstract

Aim: Increased intracranial pressure (ICP) in hypoxic ischaemic brain injury (HIBI) can cause secondary ischaemic brain injury and culminate in brain death. Invasive ICP monitoring is limited by associated risks in HIBI patients. We sought to evaluate the agreement between invasive ICP measurements and non-invasive estimators of ICP (nICP) in HIBI patients. Methods: Eligible consecutive adult (age > 18) cardiac arrest patients with HIBI were included as part of a single center prospective interventional study. Invasive ICP monitoring was undertaken and nICP measurements were undertaken using: a) transcranial Doppler ultrasonography (TCD), b) optic nerve sheet diameter ultrasound (ONSD) and c) jugular venous bulb pressure (JVP). Multiple measurements applied in linear mixed-effects models were considered to obtain the correlation coefficient between ICP and nICP as well as their prediction ability to detect intracranial hypertension (ICP ≥20 mm Hg). Results: Eleven patients were included (median age of 47 [range 20-71], 8 male and 3 female). There was a linear relationship between ICP and nICP with ONSD (R=0.53 [p<0.0001]), JVP (R=0.38 [p<0.001]) and TCD (R=0.30 [p<0.01]). The ability to predict intracranial hypertension was highest for ONSD and TCD (AUC=0.96 [95% CI: 0.90-1.00] and AUC=0.91 [95% CI: 0.83-1.00], respectively). JVP presented the weakest prediction ability (AUC=0.75 [95% CI: 0.56-0.94]). Conclusions: ONSD and TCD methods demonstrated agreement with invasively-monitored ICP, suggesting their potential roles in the detection of intracranial hypertension in HIBI after cardiac arrest.

Multimodal non-invasive assessment of intracranial hypertension: an observational study

“…However, the indications for invasive ICP monitoring remain controversial in some brain conditions [4]. Although non-invasive ICP methods are not accurate enough to substitute for invasive ICP, non-invasive ICP estimation may be helpful and could be used as a "triage" method (e.g., identifying patients at high risk of developing intracranial hypertension who require specific monitoring and/or surveillance) or as a diagnostic tool in patients with unexplained alteration of consciousness outside the ICU [25][26][27][28]. As such, the non-invasive estimation of ICP has been widely investigated in braininjured patients over the last few decades [29][30][31][32][33][34].…”

Early Effects of Passive Leg-Raising Test, Fluid Challenge, and Norepinephrine on Cerebral Autoregulation and Oxygenation in COVID-19 Critically Ill Patients

“…Although COVID-19 patients are not primarily brain-injured patients, recent evidence suggests that the cerebrovascular dynamics are impaired in this cohort of patients, with altered intracranial pressure and pupillometer indexes in most cases ( 8 , 10 , 34 ). Moreover, impaired CA is associated with poor outcome not only in brain-injured patients, but also in several other groups of patients, such as sepsis and cardiac arrest ( 6 , 34 , 35 ). PLR test is often used in the clinical practice as a test to assess the need for fluids and to help in the decision of starting fluid therapy or vasopressors; however, PLR test causes an intrinsic increase in intravascular volume, with shift of intravascular fluids from the legs to the abdominal compartment.…”

Optic nerve sheath diameter measurement in hypoxic ischaemic brain injury after cardiac arrest

“…We were very pleased to read about ocularultrasonography in the interesting paper by Cardim et al 1 , where they compared three noninvasive estimators of intracranial pressure to invasively one in postcardiac arrest patients with hypoxic ischaemic brain injury.…”