Abstract
Secondary brain injury impacts patient prognosis and can lead to long-term morbidity and mortality in cases of trauma. Continuous monitoring of secondary injury in acute clinical settings is primarily limited to intracranial pressure (ICP); however, ICP is unable to identify essential underlying etiologies of injury needed to guide treatment (e.g. immediate surgical intervention vs medical management). Here we show that a novel intracranial bioimpedance monitor (BIM) can detect onset of secondary injury, differentiate focal (e.g. hemorrhage) from global (e.g. edema) events, identify underlying etiology and provide localization of an intracranial mass effect. We found in an in vivo porcine model that the BIM detected changes in intracranial volume down to 0.38 mL, differentiated high impedance (e.g. ischemic) from low impedance (e.g. hemorrhagic) injuries (p < 0.001), separated focal from global events (p < 0.001) and provided coarse ‘imaging’ through localization of the mass effect. This work presents for the first time the full design, development, characterization and successful implementation of an intracranial bioimpedance monitor. This BIM technology could be further translated to clinical pathologies including but not limited to traumatic brain injury, intracerebral hemorrhage, stroke, hydrocephalus and post-surgical monitoring.
Highlights
Secondary brain injury impacts patient prognosis and can lead to long-term morbidity and mortality in cases of trauma
Current is injected between two electrodes (I+I−) and the induced voltage measured between two different electrodes (V+V−) (Fig. 1a)
This paper presents a novel monitoring system for detecting secondary brain injury
Summary
Secondary brain injury impacts patient prognosis and can lead to long-term morbidity and mortality in cases of trauma. Over the following hours to days this damage can trigger a cascade of evolving secondary injuries[16,17,18] which can significantly impact prognosis[6,19,20] Among these delayed changes are cerebral edema, hematoma formation or expansion, decreased brain tissue oxygen tension and tissue ischemia[16,17,21]. Such injuries can vary in size, severity, location and presentation making monitoring (and detection) of such pathologies crucial for management of intracranial trauma patients. Within high-risk focal events ICP is unable to identify if the injury is Scientific Reports | (2021) 11:15454
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