Predictive Values for Time from Transducer Stopcock Closure to Accurate Intracranial Pressure Reading

Earthman, Corrie; Siaron, Kathrina B.; Wilson, Jennifer; Olson, DaiWai M.

doi:10.1007/s12028-022-01581-5

Cited by 4 publications

(7 citation statements)

References 36 publications

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“…However, there is currently no universal standard to monitor ICP monitoring, and the measurement values can be affected by such factors as measurement positions, measurement duration, and the recording methods of nurses. [23][24][25][26][27][28] This has a great effect on the comparability between such studies. Therefore, it is urgent to cooperate in the development of ICP measurement standards.…”

Section: Discussionmentioning

confidence: 99%

“…When the head position is raised, the cerebrospinal fluid will also rise, which promotes the disruption of the cerebrospinal fluid and improves cerebral blood flow, thereby reducing ICP and protecting brain cells. However, there is currently no universal standard to monitor ICP monitoring, and the measurement values can be affected by such factors as measurement positions, measurement duration, and the recording methods of nurses 23–28. This has a great effect on the comparability between such studies.…”

Section: Discussionmentioning

confidence: 99%

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A Meta-analysis of the Clinical Efficacy of the Head-of-Bed Elevation for Patients With Acquired Brain Injury

Cheng

Wang

et al. 2023

Journal of Neuroscience Nursing

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BACKGROUND: Acquired brain injury is caused by traumatic or nontraumatic factors and causes changes in cognition. Several reviews have described the influence of the head-of-bed (HOB) elevation on clinical indexes such as intracranial pressure (ICP) and cerebral perfusion pressure (CPP). However, the conclusions were inconsistent. Therefore, we aimed to evaluate the effects of HOB elevation in the care of the patients with ABI. METHODS: Two researchers independently screened the literature and extracted data. We searched PubMed, EMBASE, the Cochrane Library, Web of Science, and the Chinese Biological Literature Database to collect eligible randomized controlled trials published after September 2021. Reporting quality and methodological quality of the included studies were assessed by using the Preferred Reporting Items for Systematic Reviews and Meta-analysis and the Cochrane risk-of-bias tool. RESULTS: Eight studies were included in the meta-analysis. The results showed that, compared with the flat position, HOB elevation of 30°or 45°can significantly reduce ICP (mean difference [MD], −2.40 mm Hg; 95% confidence interval [CI], −3.19 to −1.61; P < .00001). However, there were no statistical differences in CPP (MD, −1.09; 95% CI, −3.93 to 1.75; P = .45), degree of disability at 90 days (relative risk, 1.01; 95% CI, 0.94-1.08; P = .83), and mean arterial pressure (MD, −0.44; 95% CI, −10.27 to 9.93; P = .93). CONCLUSION: Head-of-bed elevation of 30°c an reduce ICP and maintain CPP, and may be an effective noninvasive nursing practice for the prognosis and rehabilitation of ABI patients. Owing to the lack of high-quality, large-sample randomized controlled trials, more rigorous trials are needed to support this conclusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Meta-analysis of the Clinical Efficacy of the Head-of-Bed Elevation for Patients With Acquired Brain Injury

Cheng

Wang

et al. 2023

Journal of Neuroscience Nursing

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“…The presence of blood or particulate matter in the system has been identified as a potential source of measurement error, but studies have not been performed detailing the effect of transducer contamination on pressure monitoring (13). Furthermore, molecular makeup and relative viscosities of fluids effect flow rate, and therefore the ability to accurately relieve and monitor ICP (22).…”

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confidence: 99%

The Presence of Blood in a Strain Gauge Pressure Transducer Has a Clinical Effect on the Accuracy of Intracranial Pressure Readings

Nairon,

Joseph,

Kamal

et al. 2024

Critical Care Explorations

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IMPORTANCE: Patients admitted with cerebral hemorrhage or cerebral edema often undergo external ventricular drain (EVD) placement to monitor and manage intracranial pressure (ICP). A strain gauge transducer accompanies the EVD to convert a pressure signal to an electrical waveform and assign a numeric value to the ICP. OBJECTIVES: This study explored ICP accuracy in the presence of blood and other viscous fluid contaminates in the transducer. DESIGN: Preclinical comparative design study. SETTING: Laboratory setting using two Natus EVDs, two strain gauge transducers, and a sealed pressure chamber. PARTICIPANTS: No human subjects or animal models were used. INTERVENTIONS: A control transducer primed with saline was compared with an investigational transducer primed with blood or with saline/glycerol mixtures in mass:mass ratios of 25%, 50%, 75%, and 100% glycerol. Volume in a sealed chamber was manipulated to reflect changes in ICP to explore the impact of contaminates on pressure measurement. MEASUREMENTS AND MAIN RESULTS: From 90 paired observations, ICP readings were statistically significantly different between the control (saline) and experimental (glycerol or blood) transducers. The time to a stable pressure reading was significantly different for saline vs. 25% glycerol (< 0.0005), 50% glycerol (< 0.005), 75% glycerol (< 0.0001), 100% glycerol (< 0.0005), and blood (< 0.0005). A difference in resting stable pressure was observed for saline vs. blood primed transducers (0.041). CONCLUSIONS AND RELEVANCE: There are statistically significant and clinically relevant differences in time to a stable pressure reading when contaminates are introduced into a closed drainage system. Changing a transducer based on the presence of blood contaminate should be considered to improve accuracy but must be weighed against the risk of introducing infection.

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“…External ventricular drains are the most common means of monitoring ICP. Yet, this device is fraught with practice variations 3–5 . Some of the variations in practice include the following: if an EVD is left open to drain or closed to monitor ICP, how long to leave a stopcock closed before recording an ICP reading, what external landmark to use for leveling the transducer, what level to use if a patient is not supine, where to place the transducer on the EVD system, and how to zero the transducer.…”

mentioning

confidence: 99%

“…Yet, this device is fraught with practice variations. [3][4][5] Some of the variations in practice include the following: if an EVD is left open to drain or closed to monitor ICP, how long to leave a stopcock closed before recording an ICP reading, what external landmark to use for leveling the transducer, what level to use if a patient is not supine, where to place the transducer on the EVD system, and how to zero the transducer. The lack of a universal practice standard and variation in adherence to the medical device manufacturer's recommendations contrib-ute to reporting errors.…”

mentioning

confidence: 99%

Zeroing a Transducer on an External Ventricular Drain

Malloy¹

2023

Journal of Neuroscience Nursing

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BACKGROUND: External ventricular drains (EVDs) are commonly used in severely brain-injured patients to diagnose intracranial hypertension. The accuracy of the intracranial pressure reading is dependent on zeroing the external transducer to air. Recent concern about zeroing techniques has been identified in the neuroscience community. The open method requires removing the nonvented cap, and the closed method requires zeroing through the filter at the top of the burette. This critical appraisal seeks to explore whether zeroing a transducer on an EVD through the filter of the burette provides the same baseline zero as opening the transducer to air. METHODS: Independent searches in CINAHL, PubMed, and Web of Science were conducted using “external ventricular drain* OR EVD AND transducer”; secondary search terms included “zero AND transducer” AND “ventric.” RESULTS: Database search produced 1 single observation study and 2 clinical practice guidelines from neuroscience professional organizations. The single observation study provided no evidence of equivalence between the 2 zeroing methods; the 2 clinical practice guidelines reference the open method. The transducer manufacturer's instructions for use direct the clinician to open the transducer to air by removing the nonvented cap. CONCLUSION: The question “Does zeroing the transducer on an EVD through the filter of the burette provide the same baseline zero as opening the transducer to air?” cannot be answered with the results of this appraisal. However, evidence found in the literature does suggest an open method to ensure the most accurate physiological value for treatment decisions.

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Predictive Values for Time from Transducer Stopcock Closure to Accurate Intracranial Pressure Reading

Cited by 4 publications

References 36 publications

A Meta-analysis of the Clinical Efficacy of the Head-of-Bed Elevation for Patients With Acquired Brain Injury

A Meta-analysis of the Clinical Efficacy of the Head-of-Bed Elevation for Patients With Acquired Brain Injury

The Presence of Blood in a Strain Gauge Pressure Transducer Has a Clinical Effect on the Accuracy of Intracranial Pressure Readings

Zeroing a Transducer on an External Ventricular Drain

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