Risk factors of intracranial pressure monitoring in children with fiberoptic devices: A critical review

Jensen, Randy L.; Hahn, Yoon S.; Ciro, Erica

doi:10.1016/s0090-3019(96)00276-5

Cited by 50 publications

(26 citation statements)

References 26 publications

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“…8,9,16,20,30 Bellner et al, in a study involving 81 patients with mixed etiologies of neurological disease, found a strong relationship between PI and the ICP (r = 0.938, p …”

Section: Discussionmentioning

confidence: 97%

“…In general, our findings show a weaker relationship between ICP and PI than what has been demonstrated in the majority of adult studies. 8,9,16,20,30 The reasons for this difference are unclear but are likely related to the differences between adult and pediatric TBI in regards to pathology, brain tissue compliance, CSF pulsatility, and cerebrovascular control mechanisms. 22,25,30,32 The results of the 2 previous studies evaluating the utility of TCD-derived PI and Vd to noninvasively estimate ICP in pediatric patients who have suffered TBI appear to be in contrast to one another.…”

Section: < 00001)mentioning

confidence: 99%

“…9,15 Several studies have suggested that TCD-derived end diastolic flow velocity (Vd) and pulsatility index (PI) are useful as noninvasive estimates of ICP in adults with TBI. 7,8,16,19,20,29,30 There are very limited and opposing data on the utility of TCD-derived Vd and PI to noninvasively screen for intracranial hypertension and to follow ICP over time in children with TBI. 11,13,21 Given these conflicting reports in children, we designed this prospective, observational trial to further evaluate the relationship between PI, end Vd, and ICP in infants, children, and adolescents with severe TBI.…”

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confidence: 99%

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Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury

O’Brien

Maa

Reuter‐Rice

2015

PED

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OBJECT The aim of this study was to determine the relationship between transcranial Doppler (TCD) derived pulsatility index (PI), end diastolic flow velocity (Vd), and intracranial pressure (ICP). The subjects in this study were 36 children admitted after severe traumatic brain injury (TBI) (postresuscitation Glasgow Coma Scale ≤ 8) undergoing invasive ICP monitoring. METHODS Subjects underwent a total of 148 TCD studies. TCD measurements of systolic flow velocity (Vs), Vd, and mean flow velocity (Vm) were performed on the middle cerebral artery (MCA) ipsilateral to the ICP monitor. The PI was calculated by the TCD software (Vs-Vd/Vm). ICP registrations were made in parallel with TCD measurements. RESULTS Using a PI threshold of 1.3, postinjury Day 0–1 PI had 100% sensitivity and 82% specificity at predicting an ICP ≥ 20 mm Hg (n = 8). During this time frame, a moderately strong relationship was observed between the MCA PI and actual ICP (r = 0.611, p = 0.01). When using a threshold of < 25 cm/sec, postinjury Day 0-1 Vd had a 56% sensitivity to predict an ICP ≥ 20 mm Hg. Beyond the initial 24 hours from injury, the sensitivity of an MCA PI of 1.3 to detect an ICP ≥20 mm Hg was 47%, and a weak relationship between actual ICP values and MCA PI (r = 0.376, p = 0.01) and MCA Vd (r = -0.284, p = 0.01) was found. CONCLUSIONS Postinjury Day 0-1 MCA PI > 1.3 has good sensitivity and specificity at predicting an ICP ≥ 20 mm Hg. In those children with TBI who initially do not meet clear criteria for invasive ICP monitoring but who are at risk for development of intracranial hypertension, TCD may be used as a noninvasive tool to screen for the development of elevated ICP in the first 24 hours following injury.

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“…8,9,16,20,30 Bellner et al, in a study involving 81 patients with mixed etiologies of neurological disease, found a strong relationship between PI and the ICP (r = 0.938, p …”

Section: Discussionmentioning

confidence: 97%

Section: < 00001)mentioning

confidence: 99%

mentioning

confidence: 99%

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Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury

O’Brien

Maa

Reuter‐Rice

2015

PED

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“…However, intracranial hemorrhage is recognized as a possible complication following placement of an ICP monitoring device. There is a wide range in the reported incidences of this complication in the literature, from 0 to 15.3% [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27]. However, most of these published reports failed to distinguish between large hematomas requiring surgical evacuation and small punctate hemorrhages picked up on imaging only.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, insertion of an ICP monitor is felt to be a safe and effective adjunct in the management of raised ICP, with a low incidence of hemorrhagic or infectious complications [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27]. …”

Section: Introductionmentioning

confidence: 99%

Hemorrhagic Complications of Intracranial Pressure Monitors in Children

Bláha

Lazar²,

Winn³

et al. 2003

Pediatr Neurosurg

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Intracranial pressure (ICP) monitoring plays a valuable role in the management of head injuries and other causes of raised ICP in the pediatric population. The purpose of this study was to investigate the incidence of hemorrhage after ICP monitor insertion, and to classify these complications in a clinically relevant manner. Hospital charts of 431 children (ages 0–16 years) admitted to a level I trauma center over a 2-year period were reviewed and 112 patients (134 insertions) who underwent intraparenchymal ICP monitoring were identified. The authors reviewed postoperative neuroradiological studies. One hundred and nineteen procedures were carried out without any hemorrhage (grade 0). After 10 insertions, a small punctate hemorrhage or localized subarachnoid hemorrhage occurred (grade 1). Three patients sustained an intracerebral hemorrhage that did not require evacuation or manifest as a new neurological deficit (grade 2). There were no hemorrhagic complications that necessitated evacuation or resulted in a noticeable change in the patient’s clinical condition (grade 3). We propose a new grading system for hemorrhage after ICP monitor insertion. We found a complication rate close to 10% in our pediatric patients. Fortunately, these hemorrhages were clinically silent and no neurosurgical intervention was necessary. However, grade 1 and grade 2 hemorrhages may manifest with a false reading of high ICP, and the long-term consequences of these complications are not known. Of note, only 23% of these complications were reflected in the patients charts, which may explain the low complication rates reported in other studies that did not analyze postoperative neuroradiological studies.

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Functional Outcome After Intracranial Pressure Monitoring for Children With Severe Traumatic Brain Injury

et al. 2017

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IMPORTANCE Intracranial pressure (ICP) monitoring is a mainstay of therapy for children with traumatic brain injury (TBI), but its overall association with patient outcome is unclear.OBJECTIVE To test the hypothesis that ICP monitoring is associated with improved functional survival of children with severe TBI. DESIGN, SETTING, AND PARTICIPANTSA propensity-weighted effectiveness analysis was conducted using 2 linked national databases with data from 30 US children's hospitals from January 1, 2007, to December 31, 2012, on 3084 children with severe TBI. Clinical events including neurosurgical procedures were identified using validated computable phenotypes. Data analysis was conducted from September 1, 2016, to March 1, 2017.EXPOSURE Placement of an ICP monitor. MAIN OUTCOMES AND MEASURESA composite of hospital mortality, discharge to hospice, or survival with placement of new tracheostomy and gastrostomy tubes. RESULTSOf the 3084 children in the study (1128 girls and 1956 boys; mean [SD] age, 7.03 [5.44] years), 1002 (32.4%) underwent ICP monitoring, with substantial hospital variation (6% to 50% by hospital). Overall, 484 children (15.7%) experienced the primary composite outcome. A propensity approach using matching weights generated good covariate balance between those who did and those who did not undergo ICP monitoring. Using a propensity-weighted logistic regression model clustered by hospital, no statistically significant difference was found in functional survival between monitored and unmonitored patients (odds ratio of poor outcome among those who underwent ICP monitoring, 1.31; 95% CI, 0.99-1.74). In a prespecified secondary analysis, no difference in mortality was found (odds ratio, 1.16; 95% CI, 0.89-1.50). Prespecified subgroup analyses of children younger and older than 2 years of age and among those with unintentional and inflicted (intentional) injuries also showed no difference in outcome with ICP monitoring. CONCLUSIONS AND RELEVANCEWith the use of linked national data and validated computable phenotypes, no evidence was found of a benefit from ICP monitoring on functional survival of children with severe TBI. Intracranial pressure monitoring is a widely but inconsistently used technology with incompletely demonstrated effectiveness. A large prospective cohort study or randomized trial is needed.

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Risk factors of intracranial pressure monitoring in children with fiberoptic devices: A critical review

Cited by 50 publications

References 26 publications

Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury

Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury

Hemorrhagic Complications of Intracranial Pressure Monitors in Children

Functional Outcome After Intracranial Pressure Monitoring for Children With Severe Traumatic Brain Injury

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