Estimación no invasiva ultrasonográfica de la presión intracraneana en el paciente neurocrítico

Abstract

ObjectiveTo evaluate the usefulness of transcranial Doppler (TCD) and measurement of the diameter of the optic nerve sheath (ONSD) for non-invasive estimation of intracranial pressure (ICP), through the study of its correlation with invasive monitoring. DesignA prospective, single-centre study was conducted between February 2018 and August 2019 in a 26-bed Intensive Care Unit (ICU) of the public healthcare system. ParticipantsNeurocritical patients, older than 18 years, admitted consecutively to the ICU, and requiring invasive monitoring of intracranial pressure (ICP). InterventionsNone. MeasurementsThe correlation between invasive ICP and estimated ICP by TCD was performed using the Lin's concordance correlation coefficient. The ROC curve was used to assess the diagnostic accuracy of the ONSD. In all cases, a value of p < 0.05 was adopted as the level of statistical significance. ResultsThirty records of a total of 25 patients were evaluated. No significant differences were found between the median of invasive ICP vs. that estimated by TCD (16.07 vs. 15.03) (P = 0.001). A Lin Coefficient of 0.9603 (95% CI: 0.9199 to 0.9806) was found. The ONSD had an area under the curve ROC = 0.843 (P = 0.003). The cut-off value of 5.00 mm determined a sensitivity of 80% and a specificity of 80% to predict intracranial hypertension. ConclusionsThis study shows that, for our patient population, TCD and ONSD represent methods with significant diagnostic precision for the non-invasive estimation of ICP.