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Observational Study
. 2023 Jun;165(6):1495-1503.
doi: 10.1007/s00701-023-05580-z. Epub 2023 Apr 15.

Can a new noninvasive method for assessment of intracranial pressure predict intracranial hypertension and prognosis?

Matheus Ballestero  1   2 , Celeste Dias  3 , Inês Catarina Neves Gomes  3 , Luca Soares Grisi  4 , Rodrigo Augusto Monteiro Cardoso  4 , Edson Luis Zucoloto Júnior  4 , Ricardo Santos de Oliveira  4
Affiliations
Observational Study

Can a new noninvasive method for assessment of intracranial pressure predict intracranial hypertension and prognosis?

Matheus Ballestero et al. Acta Neurochir (Wien). 2023 Jun.

Abstract

Purpose: Individuals with TBI are at risk of intracranial hypertension (ICH), and monitoring of intracranial pressure (ICP) is usually indicated. However, despite many new noninvasive devices, none is sufficiently accurate and effective for application in clinical practice, particularly in the management of TBIs. This study aimed to compare the noninvasive Brain4Care system (nICP) with invasive ICP (iICP) curve parameters in their ability to predict ICH and functional prognosis in severe TBI.

Methods: Observational, descriptive-analytical, and prospective study of 22 patients between 2018 and 2021, simultaneously monitored with nICP and iICP. The independent variables evaluated were the presence of ICH and functional prognoses. The dependent variables were the P2/P1 pressure ratio metrics, time to peak (TTP), and TTP × P2/P1.

Results: We found a good nonlinear correlation between iICP and nICP waveforms, despite a moderate Pearson's linear correlation. The noninvasive parameters of P2/P1, P2/P1 × TTP, and TTP were not associated with outcomes or ICH. The nICP P2/P1 ratio showed sensitivity/specificity/accuracy (%) of 100/0/56.3, respectively for 1-month outcomes and 77.8/22.2/50 for 6-month outcomes. The nICP TTP ratio had values of 100/0/56.3 for 1-month and 99.9/42.9/72.2 for 6-month outcomes. The nICP P2/P1 × TTP values were 100/0/56.3 for 1-month outcomes and 81.8/28.6/61.1 for 6-month outcomes.

Conclusion: Brain4Care's noninvasive method showed low specificity and accuracy and cannot be used as the sole means of monitoring ICP in patients with severe TBI. Future studies with a larger sample of patients with P2 > P1 and new nICP curve parameters are warranted.

Keywords: Intracranial hypertension; Intracranial pressure; Non-invasive techniques; Prognosis; Traumatic brain injury.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Behavior of P1, P2, and P3 waves in a compliant and non-compliant brain, in the lower curve the wave P1 > P2 (normal brain) and smaller TTP and in the upper curve P2 > P1 (lack of compliance of the system) and higher TTP
Fig. 2
Fig. 2
Infographic illustrating invasive and noninvasive monitoring. A brace is installed circumferentially on the skull. The sensor transmits invasive and non-invasive information obtained to a monitor simultaneously, then the intensivist can use the invasive values for clinical performance and the non-invasive data are stored for research. ICP, intracranial pressure; TTP, time to peak
Fig. 3
Fig. 3
Flowchart showing the steps used to calculate and design Isomap. Fourier transform is a mathematical model to transform the signals from time domain to frequency domain
See this image and copyright information in PMC

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