491: IMPORTANCE OF NEUROMONITORING FOR NONPRIMARY NEUROLOGIC CRITICAL PATIENTS

Abstract

Introduction: Several non-primary neurological conditions may lead to brain blood circulation impairment, as acute respiratory distress syndrome (ARDS) per example. Impairment of cerebrovascular autoregulation mechanisms also may lead to intracranial pressure (ICP) elevation and intracranial compliance (ICC) reduction. As COVID-19 severe disease is mostly characterized by ARDS, the present study aimed to evaluate the prevalence of cerebrovascular and ICC disorders in these patients. Methods: 50 consecutive artificially ventilated (AV) patients due to COVID-19 had cerebral hemodynamics (CH) assessed using transcranial Doppler (TCD), whereas intracranial compliance (ICC) was assessed using an elastance sensor. Subjects were included upon ICU admission. Prevalence of ICC and CH disturbances were calculated either to the satisfactory outcome group as 1) patients progressing to spontaneous breathing (SB), or unfavorable outcome (UO) groups as 2) unsuccessful AV weaning or 3) death within 7 days after last cerebrovascular and ICC assessments. Results: After this cohort, 17 (34%) patients reached SB successfully, whereas of the 33 (66%) patients that belonged to the UO group, 24 (48%) died during the study period. ICC impairment (p=0.03) and TCD estimated ICP (p=0.01) were significantly higher among patients with UO, with a synergism for the combination between CH and ICC disorders to predict UO (p< 0.001, with area under the curve 0.86). Mortality after the end of the study was 60% and mean length of hospitalization 31 days (11-57). Conclusions: In the present study, intracranial compliance and brain circulatory disturbances were prevalent among patients with a non-primary neurological disease. These complications seem to have impact on outcomes and alert physicians to perform neurological multimodal monitoring besides taking care of the systemic conditions of the severely ill patient.