Abstract

BackgroundMonitoring of intracranial pressure (ICP) is a cornerstone in the surveillance of neurosurgical patients. The ICP is measured against a baseline pressure (i.e. zero - or reference pressure). We have previously reported that baseline pressure errors (BPEs), manifested as spontaneous shift or drifts in baseline pressure, cause erroneous readings of mean ICP in individual patients. The objective of this study was to monitor the frequency and severity of BPEs. To this end, we performed a prospective, observational study monitoring the ICP from two separate ICP sensors (Sensors 1 and 2) placed in close proximity in the brain. We characterized BPEs as differences in mean ICP despite near to identical ICP waveform in Sensors 1 and 2.MethodsThe study enrolled patients with aneurysmal subarachnoid hemorrhage in need of continuous ICP monitoring as part of their intensive care management. The two sensors were placed close to each other in the brain parenchyma via the same burr hole. The monitoring was performed as long as needed from a clinical perspective and the ICP recordings were stored digitally for analysis. For every patient the mean ICP as well as the various ICP wave parameters of the two sensors were compared.ResultsSixteen patients were monitored median 164 hours (ranges 70 – 364 hours). Major BPEs, as defined by marked differences in mean ICP despite similar ICP waveform, were seen in 9 of them (56%). The BPEs were of magnitudes that had the potential to alter patient management.ConclusionsBaseline Pressure Errors (BPEs) occur in a significant number of patients undergoing continuous ICP monitoring and they may alter patient management. The current practice of measuring ICP against a baseline pressure does not comply with the concept of State of the Art. Monitoring of the ICP waves ought to become the new State of the Art as they are not influenced by BPEs.

Highlights

  • Monitoring of intracranial pressure (ICP) is a cornerstone in the surveillance of neurosurgical patients

  • They were all hospitalized for aneurysmal subarachnoid haemorrhage (SAH), and taken care of at the intensive care unit (ICU)

  • None of the ICP sensors seemed to be in direct contact with each other

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Summary

Introduction

Monitoring of intracranial pressure (ICP) is a cornerstone in the surveillance of neurosurgical patients. Continuous intracranial pressure (ICP) monitoring is a cornerstone in the surveillance of patients suffering traumatic brain injury or intracranial hemorrhage [1,2,3,4]. The mean ICP is calculated against a baseline reference pressure, denoted the zero pressure level. If this baseline reference pressure becomes altered, the ICP value displayed to the physician will be erroneous [5]. Such baseline pressure errors (BPEs) occur during clinical ICP monitoring [5,6], and may occur with various types of ICP sensors [6]

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