Abstract
Background Transcranial Doppler (TCD) has been used to estimate ICP noninvasively (nICP); however, its accuracy varies depending on different types of intracranial hypertension. Given the high specificity of TCD to detect cerebrovascular events, this study aimed to compare four TCD-based nICP methods during plateau waves of ICP.MethodsA total of 36 plateau waves were identified in 27 patients (traumatic brain injury) with TCD, ICP, and ABP simultaneous recordings. The nICP methods were based on: (1) interaction between flow velocity (FV) and ABP using a “black-box” mathematical model (nICP_BB); (2) diastolic FV (nICP_FVd); (3) critical closing pressure (nICP_CrCP), and (4) pulsatility index (nICP_PI). Analyses focused on relative changes in time domain between ICP and noninvasive estimators during plateau waves and the magnitude of changes (∆ between baseline and plateau) in real ICP and its estimators. A ROC analysis for an ICP threshold of 35 mmHg was performed.ResultsIn time domain, nICP_PI, nICP_BB, and nICP_CrCP presented similar correlations: 0.80 ± 0.24, 0.78 ± 0.15, and 0.78 ± 0.30, respectively. nICP_FVd presented a weaker correlation (R = 0.62 ± 0.46). Correlations between ∆ICP and ∆nICP were better represented by nICP_CrCP and BB, R = 0.48, 0.44 (p < 0.05), respectively. nICP_FVdand PI presented nonsignificant ∆ correlations. ROC analysis showed moderate to good areas under the curve for all methods: nICP_BB, 0.82; nICP_FVd, 0.77; nICP_CrCP, 0.79; and nICP_PI, 0.81.ConclusionsChanges of ICP in time domain during plateau waves were replicated by nICP methods with strong correlations. In addition, the methods presented high performance for detection of intracranial hypertension. However, absolute accuracy for noninvasive ICP assessment using TCD is still low and requires further improvement.
Highlights
Acute intracranial hypertension (ICH) is a recurrent cause of secondary injury in patients under neurocritical care
receiver operating characteristic curve (ROC) analysis showed moderate to good areas under the curve for all methods: nICP_BB, 0.82; nICP_FVd, 0.77; nICP_CrCP, 0.79; and nICP_PI, 0.81
Changes of Intracranial pressure (ICP) in time domain during plateau waves were replicated by nICP methods with strong correlations
Summary
Acute intracranial hypertension (ICH) is a recurrent cause of secondary injury in patients under neurocritical care. First described by Janny [2] in 1950 and later by Lundberg [3], plateau waves of ICP (or Lundberg A waves) [3] are characterized by sudden and relevant increases in ICP (generally above 40 mmHg [4]), related to increased volume of arterial blood in response to arterial vasodilation stimulus Such phenomena may develop in patients presenting intact cerebral autoregulation [4] and low cerebrospinal compensatory reserve [5], suffering from a wide range of cerebral pathological conditions including traumatic brain injury (TBI) [4], idiopathic intracranial hypertension [6], subarachnoid hemorrhage [7], brain tumors, hydrocephalus [8], and craniosynostosis [9]. A ROC analysis for an ICP threshold of 35 mmHg was performed
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