Non-Invasive Methods for Intracranial Pressure Monitoring in Traumatic Brain Injury Using Transcranial Doppler: A Scoping Review

Martínez-Palacios, Karol; Vásquez-García, Sebastián; Fariyike, Olubunmi A.; Robba, Chiara; Rubiano, Andrés M.

doi:10.1089/neu.2023.0001

Cited by 4 publications

(2 citation statements)

References 52 publications

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“…The IMPRESSIT-2 study, a prospective multicenter unblinded clinical trial, compared the use of TCD waveform analysis to invasive ICP in detecting elevated ICP; it demonstrated a high negative predictive value of TCP-derived measures in ruling out ICP elevation > 20 mmHg, indicating a high discriminant accuracy for excluding elevated ICP but a very low positive predictive values [13 && ]. Limitations of TCD for noninvasive ICP monitoring include challenges in obtaining reliable insonation windows in almost one third of patients, specialized expertise required to analyze and interpret TCD waveforms, and the episodic nature of data acquisition which reduces the likelihood of capturing significant events or trends [14].…”

Section: Key Pointsmentioning

confidence: 99%

Neuromonitoring in the ICU – what, how and why?

Mathur,

Meyfroidt,

Robba

et al. 2024

Current Opinion in Critical Care

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Purpose of review We selectively review emerging noninvasive neuromonitoring techniques and the evidence that supports their use in the ICU setting. The focus is on neuromonitoring research in patients with acute brain injury. Recent findings Noninvasive intracranial pressure evaluation with optic nerve sheath diameter measurements, transcranial Doppler waveform analysis, or skull mechanical extensometer waveform recordings have potential safety and resource-intensity advantages when compared to standard invasive monitors, however each of these techniques has limitations. Quantitative electroencephalography can be applied for detection of cerebral ischemia and states of covert consciousness. Near-infrared spectroscopy may be leveraged for cerebral oxygenation and autoregulation computation. Automated quantitative pupillometry and heart rate variability analysis have been shown to have diagnostic and/or prognostic significance in selected subtypes of acute brain injury. Finally, artificial intelligence is likely to transform interpretation and deployment of neuromonitoring paradigms individually and when integrated in multimodal paradigms. Summary The ability to detect brain dysfunction and injury in critically ill patients is being enriched thanks to remarkable advances in neuromonitoring data acquisition and analysis. Studies are needed to validate the accuracy and reliability of these new approaches, and their feasibility and implementation within existing intensive care workflows.

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Section: Key Pointsmentioning

confidence: 99%

Neuromonitoring in the ICU – what, how and why?

Mathur,

Meyfroidt,

Robba

et al. 2024

Current Opinion in Critical Care

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“…However, on the other hand, this sensor cannot be recalibrated after placement, and although the insertion stage is very accurate, the measured value will drift to a certain extent over time ( Al-Tamimi et al, 2009 ). Noninvasive ICP estimation methods such as optic nerve sheath diameter measurement ( Tian et al, 2023 ), transcranial Doppler (TCD) measurement of blood flow velocity and automated pupillometry are increasingly used in the field of noninvasive ICP measurement ( Giede-Jeppe et al, 2021 ; Martínez-Palacios et al, 2023 ). However, due to the high specificity between researchers and study populations, such methods require standardized training for operators.…”

Section: Introductionmentioning

confidence: 99%

A preliminary study on the application of electrical impedance tomography based on cerebral perfusion monitoring to intracranial pressure changes

Yan,

Wang,

et al. 2024

Front. Neurosci.

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BackgroundIn intracranial pathologic conditions of intracranial pressure (ICP) disturbance or hemodynamic instability, maintaining appropriate ICP may reduce the risk of ischemic brain injury. The change of ICP is often accompanied by the change of intracranial blood status. As a non-invasive functional imaging technique, the sensitivity of electrical impedance tomography (EIT) to cerebral hemodynamic changes has been preliminarily confirmed. However, no team has conducted a feasibility study on the dynamic detection of ICP by EIT technology from the perspective of non-invasive whole-brain blood perfusion monitoring. In this study, human brain EIT image sequence was obtained by in vivo measurement, from which a variety of indicators that can reflect the tidal changes of the whole brain impedance were extracted, in order to establish a new method for non-invasive monitoring of ICP changes from the level of cerebral blood perfusion monitoring.MethodsValsalva maneuver (VM) was used to temporarily change the cerebral blood perfusion status of volunteers. The electrical impedance information of the brain during this process was continuously monitored by EIT device and real-time imaging was performed, and the hemodynamic indexes of bilateral middle cerebral arteries were monitored by transcranial Doppler (TCD). The changes in monitoring information obtained by the two techniques were compared and observed.ResultsThe EIT imaging results indicated that the image sequence showed obvious tidal changes with the heart beating. Perfusion indicators of vascular pulsation obtained from EIT images decreased significantly during the stabilization phase of the intervention (PAC: 242.94 ± 100.83, p < 0.01); perfusion index which reflects vascular resistance increased significantly in the stable stage of intervention (PDT: 79.72 ± 18.23, p < 0.001). After the intervention, the parameters gradually returned to the baseline level before compression. The changes of EIT indexes in the whole process are consistent with the changes of middle cerebral artery velocity related indexes shown in TCD results.ConclusionThe EIT image combined with the blood perfusion index proposed in this paper can reflect the decrease of cerebral blood flow under the condition of increased ICP in real time and intuitively. With the advantages of high time resolution and high sensitivity, EIT provides a new idea for non-invasive bedside measurement of ICP.

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