Clinical Significance of Multiparameter Intracranial Pressure Monitoring in the Prognosis Prediction of Hypertensive Intracerebral Hemorrhage.

Yongbo Yang,Yuchun Pan,Chunlei Chen,Penglai Zhao,Chunhua Hang

doi:10.3390/jcm11030671

Abstract

Objective: The present study aimed to investigate the clinical significance of multiparameter intracranial pressure (ICP) monitoring in the prediction of the prognosis of hypertensive intracerebral hemorrhage (HICH). Methods: A retrospective analysis was performed on the clinical data of 53 HICH patients. The patients underwent removal of intracranial hemorrhage and decompressive craniectomy after admission. A ventricular ICP monitoring probe was used to continuously and invasively monitor mean arterial pressure (MAP) and ICP after surgery. The NEUMATIC system was used to collect ICP data, including pressure reactivity index (PRx), ICP dose (DICP), amplitude and pressure regression (RAP), and cerebral perfusion pressure (CPP). The mean PRx, CPP, RAP, ICP, and DICP20 mmHg × h were calculated with 1 h as the time segment. According to the Glasgow outcome scale (GOS) scores after discharge, the patients were grouped into the poor prognosis group (GOS I–III) and the good prognosis group (GOS IV and V). The two groups were compared in terms of GOS scores in the treatment and prediction of prognosis of patients. Results: The good prognosis group showed significantly lower values of mean ICP, DICP20 mmHg × h, RAP, and PRx than the poor prognosis group, while CPP was significantly higher (p < 0.001). Conclusions: PRx, DICP, RAP, and CPP could reflect intracranial changes in patients and were significantly correlated with the prognosis of the patients. Mean ICP, PRx, DICP20 mmHg × h, and RAP were negatively correlated with prognosis, while CPP was positively correlated with prognosis.

Highlights

Patients with hypertensive intracerebral hemorrhage (HICH) exhibit pathological changes such as fibrous or hyalinized degeneration in the vascular wall of the intracranial arteriole due to lasting hypertension, which weakens the elasticity of the vascular wall, eventually leading to vascular rupture and bleeding
It is critical to study multiple parameters, including the pressure reactivity index (PRx), the intracranial pressure (ICP) dose (DICP), the regression of amplitude and pressure (RAP), and the cerebral perfusion pressure (CPP), of ICP monitoring in HICH cases to determine the scientific and theoretical basis for HICH and explore an optimal analysis approach to guide the prediction of prognosis
The measurement intervals for all data were 3 seconds and were calculated with 1 h as the time segment. These parameters included ICP, PRx, RAP, CPP, and DICP obtained by calculating the area under the curve (AUC) that exceeded a threshold in the ICP curve

Summary

Introduction

Patients with hypertensive intracerebral hemorrhage (HICH) exhibit pathological changes such as fibrous or hyalinized degeneration in the vascular wall of the intracranial arteriole due to lasting hypertension, which weakens the elasticity of the vascular wall, eventually leading to vascular rupture and bleeding It is one of the most severe complications of hypertension, with 9–28% morbidity in Europe and the United States, and 19–48% in China, among patients with cerebral stroke [1,2,3]. It is likely to recur, making it one of the major diseases that endangers human health This indicates that high intracranial pressure (ICP) should be closely monitored during the treatment of patients with severe HICH.

Patient Information and Grouping

Data Extraction

Statistical Analysis

Comparison of Baseline Information between the Two Groups

Conclusions