487: A NEW TOOL TO EVALUATE THE OPTIMAL ABP THROUGH THE INTRACRANIAL PRESSURE PULSE WAVEFORM

Abstract

Introduction: Cerebral hemodynamics is an important parameter to be considered in the management of critically ill patients, unfortunately this information is not accessible to all physicians. This text will describe the use of the noninvasive sensor to monitor intracranial compliance (ICC), through the evaluation of the intracranial pressure pulse morphology (ICPwf), to adjust the arterial blood pressure (ABP) bedside. Methods: Non-invasive brain4care technology for ICC monitoring was used for the determination of appropriate ABP ranges for cerebral autoregulation. This new tool consists of a sensor positioned on the patient’s scalp and an algorithm which transforms the ICPwf in 2 numbers: P2/P1 ratio and time to peak. Results: Case1. Male patient, 40 yo with septic shock and neurological decline. The ABP was adjusted by the ICPwf analysis, the first monitoring shows an abnormal ICPwf (P2/P1 ratio of 0.56), suggesting reduced perfusion. The mean ABP was raised from 68mmHg to 90mmHg, resulting in a normal ICPwf (P2/P1 ratio of 0.81). The patient had an excellent outcome, alternating the GCS of 4 to 10 within 24 hours. Case 2. Male patient, 67 yo, head trauma due to fall from her own height. TC showed bitemporal contusion, acute subdural hematoma and midline deviation. ABP values between 75 and 85mmHg showed best ICC, confirmed by TCD. The ABP target was maintained without improvement of Glasgow Come Scale (9) and P2/P1 ratio higher than 1.2, suggestive of intracranial hypertension. A lumbar puncture was done (30ml of CSF was removed) the result was a P2/P1 ratio of 0.9, improvement of the patient’s cognitive status and better arterial blood flow velocity detected by TCD. After 14 days the patient was transferred to a rehabilitation. Case 3. Male patient, 17 yo, a victim of a car accident with GCS of 3 at scene. TC indicates diffuse axonal lesion, swelling and subgaleal hematoma. The ABP with best intracranial compliance was between 70 and 85mmHg. The patient was discharged from the ICU 16 days after the accident. Conclusions: The sensor was applicable to all patients, presenting practicality and safety. The information allowed better management and safety to the patient and physicians, optimization of procedures and pertinence in the conduct.