Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study

Robba, Chiara; Graziano, Francesca; Rebora, Paola; Elli, Francesca; Giussani, Carlo; Oddo, Mauro; Meyfroidt, Geert; Helbok, Raimund; Taccone, Fabio Silvio; Prisco, Lara; Vincent, Jean‐Louis; Suárez, José I.; Stocchetti, Nino; Citerio, Giuseppe; Abdelaty, Mohamed; Maillard, Samia Abed; Ahmed, Hatim S.; Albrecht, Lea; AL-Sudani, Ali A.; Amundarain, E.D.; Anand, Saurabh; Andersen, Jens Bo; Anglada, Montserrat Pujol; Arabi, Yaseen M.; Aragão, Irene; Verdu, Maria Dolores Arias; Asehnoune, Karim; Assunção, Fernanda Boldrini; Audibert, Gérard; Badenes, Rafael; Bajracharya, Tamanna; Banco, Pierluigi; Batista, Danusa Cassiana Rigo; Bertellini, Elisabetta; Gutiérrez, Hedgar Berty; Besch, Guillaume; Biston, Patrick; Ortíz, Aaron Blandino; Blazquez, V.; Bloria, Summit Dev; Bonetti, Chiara; Bresil, Piergiorgio; Brunetti, Iole; Buldini, Virginia; Caillard, Anaïs; Calamai, Italo; Carbonara, Marco; Caricato, Anselmo; Casadio, Maria Chiara; Casanova, Matías; Cavaleiro, Pedro; Lopez, M. Celaya; Chan, Chin‐Pang; Chauhan, Rajeev; Cinotti, Raphaël; Corral, Luisa; Cortegiani, Andrea; Cotoia, Antonella; Crippa, Ilaria Alice; Davidovich, V.; Bianco, S.; Diakaki, Chrysi; Dibu, Jamil; Dimoula, Aikaterina; Domeniconi, G.; Domínguez, Ligia J.; Dovbysh, N.Yu.; Duque, Paula Andrea; Eddelien, Heidi Shil; Efthymiou, Anna; Larsen, T. Egmose; Elhadi, Muhammed; Eva, E. Favre; Fencl, M.; Forjan, P.; Freitas, Rafael Limeira de; Fuest, Kristina; Fumale, M.; Gakuba, Clément; Galarza, Laura; Garcia, Monique Ferreira; Lopez, George Α.; Gelormini, Camilla; Gempeler, Andrés; Giannopoulos, Achilleas; Gimenez, María Estrella; Giugni, Aimone; Glorieux, D.; Perez, M.I. Gonzalez; Gradišek, Primož; Grandis, Marzia; Griesdale, Donald; Грицан, А.И.; Grotheer, S.; Gupta, Deepak; Hallt, E.D.; Hawthorne, Christopher; Holm, Morten Olskjær; Iasonidou, Christina; Idowu, Olufemi Emmanuel; Ioannoni, Eleonora; Izzi, Antonio; Jibaja, Manuel; Kafle, Prakash; Kandamby, Darshana Hewa; Khan, Muhammed; Khomiakov, S. V.; Kilapong, Bram; Kletečka, Jakub; Kojder, Klaudyna; Kolias, Angelos; Kontoudaki, E.; Koukoulitsios, George; Kovač, Nataša; Kozar, S.; Krieg, Sandro M.; Kurtz, Pedro; Kyriazopoulos, G.; Lamperti, Massimo; Lavicka, P.; Lencastre, Luís; Levin, Michael; Lightfoot, Roger; Lindner, Anna; Ojeda, Patricia; Lores, A.; Lucca, Marcelo Balbinot; Luthra, Ankur; Magni, Federico; Majholm, Birgitte; Makris, Demosthènes; Maldonado, Frank; Marudi, Andrea; Maskey, Safala; Mebis, Liese; Mejía-Mantilla, Jorge Humberto; Mendoza, Ray; Milivojević, Nikola; Miroz, John Paul; Monleón, Berta; Montes, José María de las Heras; Morelli, Paola; Motta, Alessandro; Mouloudi, Eleni; Muehlschlegel, Susanne; Silva, S.A. Ñamendys; Nardai, Gábor; Nilam, K.; Olson, Dai Wai M.; Ozair, Ahmad; Pacheco, Carlos; Juan, J. Padilla; Palli, Eleni; Panda, Nidhi; Pantelas, Nikolaos; Pariente, Laura; Pearson, David; Pérez‐Araos, Rodrigo; Picetti, Edoardo; Portilla, J.; Pons, Bertrand; Pozzi, Federico; Provaznikova, Eva; Quartarone, M; Quintard, Hervé; Rajbanshi, Lalit Kumar; Reade, Michael C.; Ribarič, Samo; Rigamonti, Andrea; Rivera, Luis; Roberts, John; Roka, Yam Bahadur; Sabeļņikovs, Oļegs; Sapra, Harsh; Schaller, Stefan J.; Sekhon, Mypinder S.; Sellami, W.; Seppelt, Ian; Serrano, Aline D; Sharma, Kopal; Shrestha, Gentle S; Shum, Hoi‐Ping; Silva, S.; Simoes, Marcela; Sivakumar, Sanjeev; Siviter, Richard; Škola, Josef; Škoti, M.; Smitt, Margit; Soley, Rafael; Sonneville, Romain; Soragni, Alessandra; Soyer, Benjamin; Špatenková, Věra; Stamou, E; Stival, Eleonora; Olson, Z.; Tánczos, Krisztián; Thompson, C.; Thomsen, Jakob Edelberg; Tsikriki, S; Velde, Stijn Van de; Videtta, Walter; Villa, Federica; Vrbica, Kamil; Vrettou, Charikleia; Hoffmeyer, H; Wolf, Stefan; Wayhs, Sâmia Yasin; Zerbi, Simone Maria

doi:10.1016/s1474-4422(21)00138-1

Cited by 124 publications

(66 citation statements)

References 31 publications

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“…Surgery for mass lesion removal or decompressive craniectomy (DC) changes brain architecture and dynamics [14], which makes ICP thresholds also change. In this environment, multimodal monitoring becomes essential to guide therapeutic interventions [6,15,16]. Although neurosurgical procedures are effective for ICP control, morbidity remains high, which might be explained by the persistence of low ICC (despite ICP under acceptable standards).…”

Section: Figurementioning

confidence: 99%

“…Nevertheless, the ICP threshold value for intervention is still uncertain. The continuous assessment and monitoring of ICP, including waveform quality, is also strongly recommended [6]. In addition, the committee indicated that further research into the relationship between ICP and clinical outcomes will benefit from automated, high-resolution monitoring and alternate forms of analysis [5].…”

Section: Introductionmentioning

confidence: 99%

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Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

et al. 2021

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Background: Morphological alterations in intracranial pressure (ICP) pulse waveform (ICPW) secondary to intracranial hypertension (ICP >20 mmHg) and a reduction in intracranial compliance (ICC) are well known indicators of neurological severity. The exclusive exploration of modifications in ICPW after either the loss of skull integrity or surgical procedures for intracranial hypertension resolution is not a common approach studied. The present study aimed to assess the morphological alterations in ICPW among neurocritical care patients with skull defects and decompressive craniectomy (DC) by comparing the variations in ICPW features according to elevations in mean ICP values. Methods: Patients requiring ICP monitoring because of acute brain injury were included. A continuous record of 10 min-length for the beat-by-beat analysis of ICPW was performed, with ICP elevation produced by means of ultrasound-guided manual internal jugular vein compression at the end of the record. ICPW features (peak amplitude ratio (P2/P1), time interval to pulse peak (TTP) and pulse amplitude) were counterweighed between baseline and compression periods. Results were distributed for three groups: intact skull (exclusive burr hole for ICP monitoring), craniotomy/large fractures (group 2) or DC (group 3). Results: 57 patients were analyzed. A total of 21 (36%) presented no skull defects, 21 (36%) belonged to group 2, whereas 15 (26%) had DC. ICP was not significantly different between groups: ±15.11 for intact, 15.33 for group 2 and ±20.81 mmHg for group 3, with ICP-induced elevation also similar between groups (p = 0.56). Significant elevation was observed for the P2/P1 ratio for groups 1 and 2, whereas a reduction was observed in group 3 (elevation of ±0.09 for groups 1 and 2, but a reduction of 0.03 for group 3, p = 0.01), and no significant results were obtained for TTP and pulse amplitudes. Conclusion: In the present study, intracranial pressure pulse waveform analysis indicated that intracranial compliance was significantly more impaired among decompressive craniectomy patients, although ICPW indicated DC to be protective for further influences of ICP elevations over the brain. The analysis of ICPW seems to be an alternative to real-time ICC assessment.

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Section: Figurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

et al. 2021

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“…Regarding invasive methods, the external ventricular drain is considered the gold standard for ICP monitoring ( 1 ). A study with a large cohort recently indicated the significant impact of ICP monitoring on outcomes for patients with an acute brain injury, despite the considerable heterogeneity of therapy protocols among specialized centers ( 5 ). Before this study, the efficacy of treatments based on invasive ICP monitoring for improving outcomes such as mortality, impaired consciousness, and functional and psychological status after hospital discharge was questionable ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Intracranial Compliance Concepts and Assessment: A Scoping Review

et al. 2021

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Background: Intracranial compliance (ICC) has been studied to complement the interpretation of intracranial pressure (ICP) in neurocritical care and help predict brain function deterioration. It has been reported that ICC is related to maintaining ICP stability despite changes in intracranial volume. However, this has not been properly translated to clinical practice. Therefore, the main objective of this scoping review was to map the key concepts of ICC in the literature. This review also aimed to characterize the relationship between ICC and ICP and systematically describe the outcomes used to assess ICC using both invasive and non-invasive measurement methods.Methods: This review included the following: (1) population: animal and humans, (2) concept of compliance or its inverse “elastance,” and (3) context: neurocritical care. Therefore, literature searches without a time frame were conducted on several databases using a combination of keywords and descriptors.Results and Discussion: 43,339 articles were identified, and 297 studies fulfilled the inclusion criteria after the selection process. One hundred and five studies defined ICC. The concept was organized into three main components: physiological definition, clinical interpretation, and localization of the phenomena. Most of the studies reported the concept of compliance related to variations in volume and pressure or its inverse (elastance), primarily in the intracranial compartment. In addition, terms like “accommodation,” “compensation,” “reserve capacity,” and “buffering ability” were used to describe the clinical interpretation. The second part of this review describes the techniques (invasive and non-invasive) and outcomes used to measure ICC. A total of 297 studies were included. The most common method used was invasive, representing 57–88% of the studies. The most commonly assessed variables were related to ICP, especially the absolute values or pulse amplitude. ICP waveforms should be better explored, along with the potential of non-invasive methods once the different aspects of ICC can be measured.Conclusion: ICC monitoring could be considered a complementary resource for ICP monitoring and clinical examination. The combination and validation of invasive/non-invasive or non-invasive measurement methods are required.

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“…Continuous invasive intracranial pressure (ICP) monitoring is crucial for the management of intracranial hypertension (ICH) in the intensive care setting [1,2]. Conventional ICP monitoring methods include trepanation and insertion of a catheter through the skull for quantitative ICP measurements [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…However, this procedure exposes the patients to several risks that limit its applicability [7][8][9]. Moreover, ICP monitoring is not always available for patients in need in many places worldwide [2]. These disadvantages indicate the need for a less invasive method of ICP monitoring [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

A Novel Noninvasive Technique for Intracranial Pressure Waveform Monitoring in Critical Care

Brasil¹,

Solla²,

Nogueira³

et al. 2021

Preprint

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We validated a new noninvasive tool (B4C) to assess intracranial pressure waveform (ICPW) morphology in a set of neurocritical patients, correlating the data with ICPW obtained from invasive catheter monitoring. Materials and Methods: Patients undergoing invasive intracranial pressure (ICP) monitoring were consecutively evaluated using the B4C sensor. Ultrasound-guided manual internal jugular vein (IJV) compression was performed to elevate ICP from the baseline. ICP values, amplitudes, and time intervals (P2/P1 ratio and time-to-peak [TTP]) between the ICP and B4C waveform peaks were analyzed. Results: Among 41 patients, the main causes for ICP monitoring included traumatic brain injury, subarachnoid hemorrhage, and stroke. Bland-Altman’s plot indicated agreement between the ICPW parameters obtained using both techniques. The strongest Pearson’s correlation for P2/P1 and TTP was observed among patients with no cranial damage (r = 0.72 and 0.85, respectively) in detriment of those who have undergone craniotomies or craniectomies. P2/P1 values of 1 were equivalent between the two techniques (area under the receiver operator curve [AUROC], 0.9) whereas B4C cut-off 1.2 was predictive of intracranial hypertension (AUROC 0.9, p < 000.1 for ICP > 20 mmHg). Conclusion: B4C provided biometric amplitude ratios correlated with ICPW variation morphology and is useful for noninvasive critical care monitoring.

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Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study

Cited by 124 publications

References 31 publications

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Intracranial Compliance Concepts and Assessment: A Scoping Review

A Novel Noninvasive Technique for Intracranial Pressure Waveform Monitoring in Critical Care

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