Intracranial Pressure Monitoring Signals After Traumatic Brain Injury: A Narrative Overview and Conceptual Data Science Framework

Dai, Honghao; Jia, Xiaodong; Pahren, Laura; Lee, Jay; Foreman, Brandon

doi:10.3389/fneur.2020.00959

Cited by 23 publications

(30 citation statements)

References 93 publications

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“…Previous studies have focused either on the extraction of indexes or ICP areas under curve calculations to obtain measures of ICC [10]. Unfortunately, the applicability of ICP waveform-derived information to date is mostly restricted because of the need for specialized hardware and software, making these observations and findings less present in daily practice.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, in recent years the knowledge on the ICP pulse waveform (ICPW) has advanced, as well as its clinical application. ICPW is an early marker of ICC impairment [3,[7][8][9] and is mainly represented by three distinct peaks: P1 (percussion wave), P2 (tidal wave) and P3 (dicrotic wave) [10]. Under physiologic conditions, P1 produced by arterial contraction is the highest peak observed, with P2 reflecting both vascular and ventricular repercussion of pressure pulse spread.…”

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

et al. 2021

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“…Previous studies have focused either on the extraction of indexes or ICP areas under curves calculations to obtain measures of ICC [10]. To our knowledge, this is the first study on the relations of ICP peaks observing the P2/P1 ratio, time-to-peak and amplitudes variations among neurocritical patients with a slight provoked ICP elevation.…”

Section: Discussionmentioning

confidence: 96%

“…Likewise, in recent years the knowledge on the ICP pulse waveform (ICPPW) has advanced, as well as its clinical application. ICPPW is an early marker of ICC impairment [3,[7][8][9] and is mainly represented by three distinct peaks, P1 (percussion wave), P2 (tidal wave) and P3 (dicrotic wave) [10].…”

Section: Recently the International Multidisciplinary Consensus Conference On Multimodalitymentioning

confidence: 99%

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Brasil

Solla

Nogueira

et al. 2021

Preprint

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Background: Morphological alterations in intracranial pressure pulse waveform (ICPPW) secondary to intracranial hypertension (ICP >20 mmHg) and reduction in intracranial compliance (ICC) are well known indicators of neurological severity. To date, no studies have documented the ICPPW modifications after intracranial hypertension resolution with decompressive craniectomy (DC). The present study aimed to assess the morphological alterations in ICPPW among neurocritical care patients with and without DC, by comparing the variations of ICPPW features according to elevations in mean ICP values. Methods: Patients requiring ICP monitoring because of severe traumatic or spontaneous conditions were included. Mean ICP values were compared with ICPPW features (P2/P1 ratio, TTP and pulse amplitude). Elevation in ICP was produced by means of ultrasound-guided manual internal jugular veins compression. 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. 21 (36%) presented no skull defects, whereas 15 (26%) had DC. ICP was not significantly different between groups: ±13.59 for intact and ±17.66 mmHg for DC, with ICP induced elevation also similar between groups (p= 0.56). Significant elevation was observed for P2/P1 ratio for groups 1 and 2, whereas reduction was observed in group 3 (elevation of ±0.09 for groups 1 and 2, whereas reduction of 0.03 for group 3, p=0.01). Conclusion: In the present study, intracranial pressure pulse waveform analysis indicated that intracranial compliance was significantly more impaired among decompressive craniectomy patients, although ICPPW indicated DC to be protective for further influences of ICP elevations over the brain. Analysis of ICPPW seems to be an alternative to real time ICC assessment.

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“…In this sense, it is a more flexible model than e.g., standard autoregressive time series models or even traditional neural network models, where raw observations are generally used as predictors. Time and frequency domain features and use of waveforms can reveal complex dependencies which may be valuable for the prediction task 27 . Use of such features in our general model is straightforward.…”

Section: Discussionmentioning

confidence: 99%

Probabilistic prediction of increased intracranial pressure in patients with severe traumatic brain injury

Wijayatunga

Koskinen

Sundström

2022

Sci Rep

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Traumatic brain injury (TBI) causes alteration in brain functions. Generally, at intensive care units (ICU), intracranial pressure (ICP) is monitored and treated to avoid increases in ICP with associated poor clinical outcome. The aim was to develop a model which could predict future ICP levels of individual patients in the ICU, to warn treating clinicians before secondary injuries occur. A simple and explainable, probabilistic Markov model was developed for the prediction task ICP ≥ 20 mmHg. Predictions were made for 10-min intervals during 60 min, based on preceding hour of ICP. A prediction enhancement method was developed to compensate for data imbalance. The model was evaluated on 29 patients with severe TBI. With random data selection from all patients (80/20% training/testing) the specificity of the model was high (0.94–0.95) and the sensitivity good to high (0.73–0.87). Performance was similar (0.90–0.95 and 0.73–0.89 respectively) when the leave-one-out cross-validation was applied. The new model could predict increased levels of ICP in a reliable manner and the enhancement method further improved the predictions. Further advantages are the straightforward expandability of the model, enabling inclusion of other time series data and/or static parameters. Next step is evaluation on more patients and inclusion of parameters other than ICP.

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Intracranial Pressure Monitoring Signals After Traumatic Brain Injury: A Narrative Overview and Conceptual Data Science Framework

Cited by 23 publications

References 93 publications

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Probabilistic prediction of increased intracranial pressure in patients with severe traumatic brain injury

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