![]() ![]() ![]() Patients were included if they were 18 years or older, had sustained acute brain injury and required invasive ICP monitoring within the first 24 hours of ICU admission. Written informed consent was requested from all surviving patients as soon as they regained their mental competency (NP 1892 – EudraCT: 2014-005482-71). Since all patients had altered consciousness, the ethics committees waived the requirement for consent, as in Italy relatives are not regarded as legal representatives of the patient in the absence of a formal designation. Detailed written information was provided to the family members regarding the study protocol, the scope of research, and the safety of TCD examination. Ethics approval for all participating sites was obtained from the appropriate regulatory committees. The Brescia University Hospital served as the coordinating center for the study. Manzoni Varese Ospedale di Circolo Fondazione Macchi Genova Ospedale Galliera). This was a prospective multicenter pilot study and took place between November 2013 and August 2014 in six neurocritical care units (Brescia Spedali Civili University Hospital Brescia Fondazione Poliambulanza Pisa Azienda Ospedaliera Cisanello Lecco Azienda Ospedaliera A. In this study, we investigated if ICP estimated by means of TCD (ICPtcd) accurately identifies intracranial hypertension in patients with acute severe brain injury. Among these, methods which use transcranial Doppler (TCD) provide valuable information, as cerebral blood flow velocity has been shown to correlate with ICP. Although some techniques have potential as screening methods for intracranial hypertension, none have found a valid place within daily clinical practice. Numerous alternatives to invasive ICP measurement have been proposed in the literature. Brain intraparenchimal catheters, despite being safer, still require an invasive procedure and cannot be recalibrated once inserted, rendering the measurements prone to imprecision due to zero drift. However, this method may be cumbersome, not always available, and accompanied by an elevated complication rate due mostly to infection, hemorrhage, and catheter obstruction. Presently, the gold standard for continuous ICP monitoring is invasive measurement through insertion of a catheter within the brain ventricles (EVD) connected to an external pressure transducer. Timely diagnosis through intracranial pressure (ICP) monitoring becomes fundamental in order to guarantee prompt diagnosis and appropriate therapeutic decision-making. Future studies with adequate power are needed to confirm this result.īrain injury is frequently accompanied by episodes of intracranial hypertension, which is a potentially fatal condition. This study provides preliminary evidence that ICPtcd may accurately exclude intracranial hypertension in patients with acute brain injury. AUC was 96.0% (95% CI 89.8–100%) and the estimated best threshold was at ICPi of 24.8 mmHg corresponding to a sensitivity 100% and a specificity of 91.2%. With dichotomized ICPi (≤20 mmHg vs >20 mmHg), the sensitivity of ICPtcd was 100% all measurements with high ICPi (>20 mmHg) also had a high ICPtcd values.īland-Altman plot showed an overestimation of 6.2 mmHg (95% CI 5.08–7.30 mmHg) for ICPtcd compared to ICPi. One hundred fourteen paired measurements of ICPi and ICPtcd were gathered for analysis. ResultsĪ total of 38 patients were enrolled, and of these 12 (31.6%) had at least one episode of intracranial hypertension. Receiver operating curve (ROC) and the area under the curve (AUC) analyses were estimated after measurement averaging over time. Sensitivity and specificity, and concordance correlation coefficient between ICPi and ICPtcd were calculated. ICP estimated with TCD (ICPtcd) was compared with ICPi in three separate time frames: immediately before ICPi placement, immediately after ICPi placement, and 3 hours following ICPi positioning. This was a multicenter prospective pilot study in patients with acute brain injury requiring invasive ICP (ICPi) monitoring. We investigated if intracranial hypertension can be accurately excluded through use of TCD. Transcranial Doppler (TCD) detects variations in cerebral blood flow velocity which may correlate with intracranial pressure (ICP). Untimely diagnosis of intracranial hypertension may lead to delays in therapy and worsening of outcome. ![]()
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