A Point-of-Care Noninvasive Technique for Surrogate ICP Waveforms Application in Neurocritical Care

Brasil, Sérgio; Godoy, Daniel Agustín; Hawryluk, Gregory

doi:10.1007/s12028-023-01786-2

Cited by 9 publications

(3 citation statements)

References 45 publications

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“…3 Participants' answers distributions regarding intracranial pressure waveform (ICPW) relevance according to different intracranial pressure (ICP) levels micrometric dilations of the skull at each heartbeat. Its generated waveforms undergo automated analysis and numerical ratios as the quotient between second and first ICP waveform peaks (P2/P1) and time to peak may aid physicians detecting poor ICC [34]. Figure 4 summarizes this combination of NIM with their respective indicators.…”

Section: Discussionmentioning

confidence: 99%

“…6). These parameters, currently available exclusively in a noninvasive device [34] soon will be also included in invasive systems to gather ICP values and ICPW automated metrics [69], what will aid practitioners on interpreting ICPW changes instead of making a simple visual assessment. Given the multiple inherent variables included in this phenomenon [57], distinguishing the distinct ICPW peaks without the support of a dedicated analytics process may become difficult.…”

Section: Icpwmentioning

confidence: 99%

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A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts

Brasil,

Godoy,

Videtta

et al. 2024

Neurocrit Care

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Background Numerous trials have addressed intracranial pressure (ICP) management in neurocritical care. However, identifying its harmful thresholds and controlling ICP remain challenging in terms of improving outcomes. Evidence suggests that an individualized approach is necessary for establishing tolerance limits for ICP, incorporating factors such as ICP waveform (ICPW) or pulse morphology along with additional data provided by other invasive (e.g., brain oximetry) and noninvasive monitoring (NIM) methods (e.g., transcranial Doppler, optic nerve sheath diameter ultrasound, and pupillometry). This study aims to assess current ICP monitoring practices among experienced clinicians and explore whether guidelines should incorporate ancillary parameters from NIM and ICPW in future updates. Methods We conducted a survey among experienced professionals involved in researching and managing patients with severe injury across low-middle-income countries (LMICs) and high-income countries (HICs). We sought their insights on ICP monitoring, particularly focusing on the impact of NIM and ICPW in various clinical scenarios. Results From October to December 2023, 109 professionals from the Americas and Europe participated in the survey, evenly distributed between LMIC and HIC. When ICP ranged from 22 to 25 mm Hg, 62.3% of respondents were open to considering additional information, such as ICPW and other monitoring techniques, before adjusting therapy intensity levels. Moreover, 77% of respondents were inclined to reassess patients with ICP in the 18–22 mm Hg range, potentially escalating therapy intensity levels with the support of ICPW and NIM. Differences emerged between LMIC and HIC participants, with more LMIC respondents preferring arterial blood pressure transducer leveling at the heart and endorsing the use of NIM techniques and ICPW as ancillary information. Conclusions Experienced clinicians tend to personalize ICP management, emphasizing the importance of considering various monitoring techniques. ICPW and noninvasive techniques, particularly in LMIC settings, warrant further exploration and could potentially enhance individualized patient care. The study suggests updating guidelines to include these additional components for a more personalized approach to ICP management.

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Section: Discussionmentioning

confidence: 99%

Section: Icpwmentioning

confidence: 99%

A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts

Brasil,

Godoy,

Videtta

et al. 2024

Neurocrit Care

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“…34 Raised ICP and reduced compliance are also associated with a longer time to the pulse peak (TTP). 35,36 To assess the morphological features associated with raised ICP and compliance, we determined the amplitude of the pulse at 45% (early diastole) relative to 10% (early systole) of the pulse period: the "DS ratio". This straightforward feature extraction provides a comparable value to the P2/P1 ratio.…”

Section: Icpmentioning

confidence: 99%

Cerebrovascular Responses in a Patient with Lundberg B Waves Following Subarachnoid Haemorrhage Assessed with a Novel Non-Invasive Brain Pulse Monitor: A Case Report

Teo,

Petautschnig,

Hellerstedt

et al. 2024

MDER

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Subarachnoid haemorrhage (SAH) can trigger a range of poorly understood cerebrovascular responses that may play a role in delayed cerebral ischemia. The brain pulse monitor is a novel non-invasive device that detects a brain photoplethysmography signal that provides information on intracranial pressure (ICP), compliance, blood flow and tissue oxygen saturation. We monitored the cerebrovascular responses in a patient with Lundberg B waves following a SAH. The patient presented with a Fischer grade 4 SAH that required urgent left posterior communicating artery aneurysm coiling and ventricular drain insertion. On hospital day 4 oscillations or spikes on the invasive ICP were noted, consistent with Lundberg B waves. Brain pulse monitoring demonstrated concurrent pulse waveform features consistent with reduced brain compliance and raised ICP over both brain hemispheres. Oxygen levels also demonstrated slow oscillations correlated with the ICP spikes. Brief infrequent episodes of reduced and absent brain pulses were also noted over the right hemisphere. Our findings suggest that the brain pulse monitor holds promise for early detection of delayed cerebral ischemia and could offer insights into the vascular mechanisms at play.

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Noninvasive neuromonitoring in acute brain injured patients

Brasil,

Chesnut,

Robba

2024

Intensive Care Med

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A Point-of-Care Noninvasive Technique for Surrogate ICP Waveforms Application in Neurocritical Care

Cited by 9 publications

References 45 publications

A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts

A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts

Cerebrovascular Responses in a Patient with Lundberg B Waves Following Subarachnoid Haemorrhage Assessed with a Novel Non-Invasive Brain Pulse Monitor: A Case Report

Noninvasive neuromonitoring in acute brain injured patients

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