Fiberoptic Intracranial Pressure Monitor Research Articles

Study of Intracranial Pressure Monitoring In Traumatic Brain Injury

Intracranial pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently. However, the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. We conducted a trial in which we included 26 patients of all types of traumatic brain injury (TBI) and they were monitored for intracranial pressure by Conventional fluid filled system with a manometer (Group 1) and compared with the Fiber optic transducer-tipped intracranial pressure monitoring system (Group 2).The main aim of this study was to examine the relationship between Intracranial Pressure (ICP) monitoring and in-hospital mortality. The median length of stay in the ICU was similar in the two groups (12 days in the conventional pressure-monitoring group and 9 days in the new fiber optic group; P=0.25), the number of days of brain-specific treatments (e.g., administration of hyperosmolar fluids and the use of hyperventilation) in the ICU was similar in both groups. The distribution of serious adverse events was similar in the two groups. We concluded that ICP monitoring (as is any monitoring modality) is a useful guide for management. The outcomes are decided by the differences in management protocols that the knowledge of the said parameter brings about. ICP monitoring is recommended for the better management of traumatic brain injury and fiber optic ICP monitoring seems to be beneficial than using the conventional methods of ICP monitoring with manometer.Nepal Journal of Neuroscience, Volume 15, Number 2, 2018, page: 23-29

Neurologic outcomes with cerebral oxygen monitoring in traumatic brain injury

Optimizing cerebral oxygenation is advocated to improve outcome in head-injured patients. The purpose of this study was to compare outcomes in brain-injured patients treated with 2 types of monitors. Patients with traumatic brain injury and a Glasgow Coma Scale score<8 were identified on admission. A polarographic cerebral oxygen/pressure monitor (Licox) or fiberoptic intracranial pressure monitor (Camino) was inserted. An evidence-based algorithm for treatment was implemented. Elements from the prehospital and emergency department records and the first 10 days of intensive care unit (ICU) care were collected. Glasgow Outcome Scores (GOS) were determined every 3 months after discharge. Over a 3-year period, 145 patients were entered into the study; 81 patients in the Licox group and 64 patients in the Camino group. Mortality, hospital length of stay, and ICU length of stay were equivalent in the 2 groups. More patients in the Licox group achieved a moderate/recovered GOS at 3 months than in the Camino Group (79% vs 61%; P = .09). Three-month GOS revealed a clinically meaningful 18% benefit in patients undergoing cerebral oxygen monitoring and optimization. Six-month outcomes were also better. Unfortunately, these important differences did not reach significance. Continued study of the benefits of cerebral oxygen monitoring is warranted.

The Camino intracranial pressure device in clinical practice. Assessment in a 1000 cases

Intracranial pressure (ICP) monitoring has become standard in the management of neurocritical patients. A variety of monitoring techniques and devices are available, each offering advantages and disadvantages. Analysis of large populations has never been performed. A prospective study was designed to evaluate the Camino fiberoptic intraparenchymal cerebral pressure monitor for complications and accuracy. Between 1992-2004 one thousand consecutive patients had a fiberoptic ICP monitor placed. The most frequent indication for monitoring was severe head injury (697 cases). The average duration of ICP monitoring was 184.6 +/- 94.3 hours; the range was 16-581 hours. Zero drift (range, -17 to 21 mm Hg; mean 7.3 +/- 5.1) was recorded after the devices were removed from 624 patients. Mechanical complications such as: breakage of the optical fiber (n = 17); dislocations of the fixation screw (n = 15) or the probe (n = 13); and failure of ICP recording for unknown reasons (n = 4) were found in 49 Camino devices. The Camino ICP sensor remains one of the most popular ICP monitoring devices for use in critical neurosurgical patients. The system offers reliable ICP measurements in an acceptable percentage of device complications and the advantage of in vivo recalibration. The incidence of technical complications was low and similar to others devices.

Continuous Antibiotic Prophylaxis and Cerebral Spinal Fluid Infection in Patients with Intracranial Pressure Monitors

Inconsistencies in the recommendation of prophylactic antibiotics for patients with intracranial pressure monitors compelled us to assess the effect of our standard regimen of continuous antibiotic prophylaxis on cerebrospinal fluid infection. We examined the rate, possible risk factors, causative organisms, and characteristics of infection. Three hundred eleven patients admitted between September 1998 and February 2001 with an intracranial pressure monitoring device in place were included. Two hundred eleven patients received a ventriculostomy, 95 an intraparenchymal fiber optic intracranial pressure monitor (ICPM), and 5 both an ICPM and a ventriculostomy. The overall infection rate was 5.5% (17/311). No patient with an ICPM developed CSF infection. The infection rate among ventriculostomy patients was 8.1% (17/211). The majority of infections (82%) were caused by Gram-positive species. Younger age (OR=1.04 for each year, 95% CI=1.01-1.08, p=0.03) and increasing duration of ventriculostomy insertion (OR=1.2 for each day of catheter insertion, 95% CI=1.1-1.3, p<0.001) were risk factors for CSF infection in multivariate analysis. Infected patients experienced longer lengths of stay in the NICU (p<0.001) and hospital (p<0.001); however, infection did not impact clinical outcome, as measured by mortality and discharge GCS. ICP monitors have a low overall infection rate. When infection occurs, gram positive organisms predominate. For patients with ventriculostomy, duration of catheter insertion strongly predicts infection, but did not alter in-hospital mortality.

Effect of baicalin and tetramethyl pyrazine on intracranial hypertension of infectious brain edema in rabbits

To evaluate the effects of mannitol (MN), baicalin (BC) and tetramethylpyrazine (TMPZ) on intracranial hypertension (ICH) of infectious brain edema induced by Pertussis bacilli (PB) in rabbits. Forty-five rabbits were divided randomly into five groups: the normal saline group (A); the pertussis bacilli group (B); the MN treated group (C); the TMPZ treated group (D) and the BC treated group (E). PB was injected into the left internal carotid artery of rabbits to establish the infectious brain edema model, their intracranial pressure (ICP) was monitored continuously by fiberoptic ICP monitor. Treatments were given intravenously 1 hour after injecting PB, and changes of ICP, brain water content (WC), Evans blue (EB), Na+, K+ and morphology were observed within 4 hours after PB or NS injection. MN, TMPZ and BC all could reduce the brain edema and ICH in rabbits induced by PB, the effect of MN was the most rapid and obvious one, but it lasted for rather shorter time, while the effect of TMPZ and BC was initiated later but lasted for a longer time. The ICP of Group C in 2nd to 4th hour was higher than that of Group D and Group E, but lower than that of Group B. The ICP of Group E in 3rd to 4th hour was lower than that of group D. At the same time of lowering ICP, brain WC, EB, Na+ contents and pathologic morphologic change were also alleviated. Both BC and TMPZ could reduce ICP in infectious brain edema, the effect of BC was better than that of TMPZ.

Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome.

The aim of this study was to assess the effectiveness of an algorithm used to evaluate and prescribe treatment for patients having slit ventricle syndrome (SVS). All patients included in this protocol underwent fiberoptic intracranial pressure monitoring after removal or externalization of their ventricular shunt systems. A significant number of patients did not need extracranial cerebrospinal fluid (CSF) diversion and tolerated removal of their shunt systems without requiring further intervention. Patients who demonstrated a need for CSF drainage underwent an endoscopic third ventriculostomy, regardless of the putative cause of their hydrocephalus. Sixteen (72.7%) of 22 patients experienced resolution of or significant improvement in their SVS complaints after their inclusion in the protocol. Concomitantly, 14 (64%) of 22 patients were no longer shunt dependent after a mean follow-up period of 21.4 months. A significant number of patients debilitated by SVS may experience improvement in their symptoms and undergo shunt removal according to this protocol, improving their quality of life and simplifying their medical follow up.

Complications of brain tissue pressure monitoring with a fiberoptic device.

Seventy-five patients with intracranial hypertension whose Glasgow Coma Score (GCS) was 8 or below and in whom intracranial pressure (ICP) was monitored were examined for complications of this procedure. In 20 of the 75 patients we used only an intraparenchymal fiberoptic ICP monitoring transducer, while, in the remaining 55 patients, who required CSF drainage, a ventricular drainage set (VDS) was used in addition to ICP monitoring. The duration of monitoring with the ICP transducer alone was approximately 5.1+/-2.6 das (min. 1, max. 13) and that of ICP monitoring with VDS was 6.2+/-3.1 days (min. 1, max. 13). In 8 cases a total of 9 complications were experienced (12%). These complications were infection in 3 cases (4%), epidural hematoma in 2 cases (2.7%), disconnection in 2 cases (2.7%) and contusion in 2 cases (2.7%). Although none of the 44 patients who were monitored for less than 5 days experienced infection, 3 of the 31 patients monitored for longer than 5 days did experience infection (9.7%) (p<0.05). None of the 20 patients who underwent ICP monitoring only experienced infection. However, 3 of the 55 patients in whom the ventricular drainage set was implanted in addition to the transducer for ICP monitoring experienced infection (p<0.05). Owing to its minimally invasive nature, low complication rate, and accuracy in monitoring the parenchyma pressure, the Camino fiberoptic intraparenchymal monitor has become the system of choice in our clinic.

Fiberoptic Intracranial Pressure Monitoring during Magnetic Resonance Imaging

Fiberoptic Intracranial Pressure Monitoring during Magnetic Resonance Imaging

Acute, unilateral transverse sinus occlusion during craniectomy in seven dogs with space-occupying intracranial disease.

The purpose of this study was to determine the effect of acute, unilateral transverse sinus occlusion on intracranial pressure (ICP) and postoperative mortality in dogs with structural intracranial disease. Affected dogs had a single transverse sinus occluded during craniectomy for intracranial mass biopsy or removal. Seven dogs with space-occupying intracranial disease in the cerebellopontine angle area. The ipsilateral transverse sinus was permanently occluded during the surgical approach to the intracranial lesion to increase surgical exposure by allowing a caudal lateral rostrotentorial craniectomy to be combined with a suboccipital craniectomy. In five dogs, intracranial pressure was monitored during surgery using a fiberoptic intracranial pressure monitoring device. Initial ICP varied among dogs, ranging from 7 to 21 mm Hg. Intracranial pressure, however, decreased in all dogs after craniectomy and durotomy (P < .05). No increase in intracranial pressure occurred after transverse sinus occlusion (P = .42). All dogs survived the surgical procedure. Acute, unilateral transverse sinus occlusion during craniectomy in dogs with space-occupying intracranial lesions did not result in significant increases in ICP or intraoperative mortality. Acute, unilateral transverse sinus occlusion during craniectomy can be used to increased surgical exposure to the caudal fossa of the brain without increased risk of increasing ICP.

Risk factors of intracranial pressure monitoring in children with fiberoptic devices: A critical review

Intracranial pressure (ICP) monitoring has become standard in the management of severe head injuries. A variety of monitoring techniques and devices are available, each with advantages and disadvantages; however there have been few studies in the pediatric population. To study the risk factors, efficacy, and complication rate of fiberoptic ICP monitoring we studied 98 consecutive children with severe head injuries over a 2-year period. The average patient age was 9 years and most had an initial Childrens Coma Score (CCS) of 8 or less. The monitoring devices were placed in frontal parenchyma of all children and no prophylactic antibiotics were used. All fiberoptic catheter tips were cultured upon removal. The average duration of ICP monitoring was 7 days; the usual range was 3-15 days, with the exception of one patient who underwent monitoring for 40 days. No complications occurred during insertion of the ICP monitors. Catheter tip cultures were positive for Staphylococcus epidermidis in 7% of the children, but none developed clinical features of CNS infection. The hospital location of placement or duration of ICP monitoring did not affect the rate of catheter tips with positive cultures. There was a 13% mechanical failure rate of the fiberoptic device. We conclude that fiberoptic ICP monitoring is safe and effective; however, there is a relatively low mechanical failure rate. Infection in uncommon despite prolonged use and there is little risk of complications associated with placement of this monitor.

The beaten copper cranium: a correlation between intracranial pressure, cranial radiographs, and computed tomographic scans in children with craniosynostosis.

The beaten copper appearance of the cranium, as well as other cranial radiographic and computed tomographic findings in children with craniosynostosis, is often interpreted by clinicians as evidence of elevated intracranial pressure (ICP). However, a correlation between radiological findings and ICP measurements has not been previously demonstrated, and their usefulness in detecting elevated ICP has not been defined. To address those issues, 123 children with craniosynostosis who had cranial radiographs and ICP monitoring were studied. To assess the specificity of certain radiological findings to patients with craniosynostosis, cranial radiographs of patients with craniosynostosis were compared to those of age- and sex-matched controls. In patients with craniosynostosis, findings on cranial radiographs were compared to computed tomographic scans of the brain. Radiographic findings were then correlated with ICP measurements obtained while the patient was sleeping, which was measured using a Camino fiberoptic ICP monitor (Camino Laboratories, San Diego, CA). All radiographs were independently analyzed by two radiologists who were blinded to clinical and ICP data. A diffuse beaten copper pattern, erosion of the dorsum sellar, and suture diastasis were seen more commonly in patients with craniosynostosis than in controls (P < 0.05), but the presence of the beaten copper pattern was no more common in children with craniosynostosis. ICP was greater when a diffuse beaten copper pattern, dorsum sellar erosion, suture diastasis, or narrowing of basal cisterns was present (P < 0.05). Although this study demonstrates that some cranial radiographic and computed tomographic findings do correlate with elevated ICP, the sensitivity of radiological methods for detecting elevated ICP is universally low and they are not recommended to screen for elevated ICP in children with craniosynostosis.

Surgical Management of Patients with Severe Head Injuries

Minutes can make the difference between life and death when patients with severe head injuries require surgery. Subdural, epidural, and intracerebral hematomas and cerebral contusions and gunshot wounds are the pathologic entities encountered most frequently during emergency surgery in patients with severe head injuries. Neurosurgical team members frequently use hyperventilation, mannitol and barbiturates, and sophisticated monitoring modalities to manage patients with severe head injuries during and after surgery. Although monitoring a patient's intracranial pressure (ICP) through a ventriculostomy catheter remains the most widely used gauge of cerebral metabolism, neurosurgical teams also are using fiber-optic ICP monitoring catheters, cerebral blood flow measurement probes, microdialysis catheters, jugular venous oxygen saturation catheters, and brain oxygen content measurement electrodes. Coordinated teamwork by perioperative nurses, neurosurgeons, anesthesia care providers, and emergency department staff members helps ensure the best possible outcomes for patients who require surgery for management of severe head injuries.

Surgical Management of Patients With Severe Head Injuries

ABSTRACT Minutes can make the difference between life and death when patients with severe head injuries require surgery. Subdural, epidural, and intracerebral hematomas and cerebral contusions and gunshot wounds are the pathologic entities encountered most frequently during emergency surgery in patients with severe head injuries. Neurosurgical team members frequently use hyperventilation, mannitol and barbiturates, and sophisticated monitoring modalities to manage patients with severe head injuries during and after surgery. Although monitoring a patient's intracranial pressure (ICP) through a ventriculostomy catheter remains the most widely used gauge of cerebral metabolism, neurosurgical teams also are using fiber-optic ICP monitoring catheters, cerebral blood flow measurement probes, microdialysls catheters, jugular venous oxygen saturation catheters, and brain oxygen content measurement electrodes. Coordinated teamwork by perioperative nurses, neurosurgeons, anesthesia care providers, and emergency department staff members helps ensure the best possible outcomes for patients who require surgery for management of severe head injuries. AORN J 63 (May 1996) 854–867.

Sufentanil Increases Intracranial Pressure in Patients with Head Trauma

Sufentanil is an intravenous opioid often used as a component of anesthesia during neurosurgical procedures. However, the effects of sufentanil on intracranial pressure in patients with diminished intracranial compliance are not well established, and remain controversial. Ten patients with head trauma, in each of whom the trachea was intubated, were studied for the effects of sufentanil on intracranial pressure (ICP) and on cerebral perfusion pressure (CPP). In all patients, ICP monitoring was instituted before the study. Sedation was obtained using a propofol infusion, and paralysis was achieved with vecuronium. After obtaining control of ICP (between 15 and 25 mmHg) hemodynamic values and blood gas tensions (PaCO2 between 30 and 35 mmHg), the level of sedation was deepened with an intravenous injection of sufentanil (1 microgram/kg over 6 min), followed by an infusion of 0.005 microgram.kg-1min-1. Mean arterial pressure (MAP), ICP (fiberoptic intracranial pressure monitor), and end-tidal CO2 were continuously measured and recorded at 1-min intervals throughout the 30-min study period. Sufentanil injection was associated with a statistically significant increase in ICP of 9 +/- 7 mmHg (+ 53%), which peaked at 5 min. Then ICP gradually decreased and returned to baseline after 15 min. This was accompanied by a significant decrease in MAP (24% decrease) and, thus, CPP (38% decrease). After 5 min, MAP and CPP gradually increased, but remained significantly decreased throughout the study. The results of the current study indicate that caution should be exercised in the administration of sufentanil bolus to patients with abnormal intracranial elastance, particularly if ICP is significantly increased.

Clinical experience with a fiberoptic intracranial pressure monitor

Retrospective clinical experience with our first 46 patients monitored with a fiberoptic intracranial pressure device is described. In 43 of 46 patients, the transducer was introduced into brain parenchyma. A ventriculostomy system was used in 3 of 46 patients. The monitoring system was generally characterized by ease of placement and system maintenance and by technical simplicity. Several problems were encountered, including breakage of system components (12%), erroneous readings requiring transducer repositioning (8.6%), epidural hematoma (3.4%), and infection (1.7%). No infections or hematomas occurred in the 3 cases in which the ventriculostomy system was used. Overall, our experience with the Camino intracranial pressure fiberoptic monitoring system confirms previous reports of its favorable features.

Evaluation of a fiberoptic intracranial pressure monitor

The fiberoptic device is a relatively new type of intracranial pressure (ICP) monitor which appears to offer certain advantages over conventional monitoring systems, particularly its ability to measure brain parenchymal pressures. This study was undertaken to analyze the accuracy and drift characteristics of the fiberoptic device and to compare pressures in the subdural, intraparenchymal, and intraventricular compartments. The device was accurate to +/- 3 mm Hg over a 0- to 30-mm Hg range in vitro. The maximum daily drift was +/- 2.5 mm Hg, with an average daily drift of +/- 0.6 mm Hg and an average drift over a 5-day period of +/- 2.1 mm Hg. In vivo, the pressures and waveform characteristics obtained with the fiberoptic device and with a strain-gauge transducer connected to a ventriculostomy were very similar. Alterations in ICP were induced by various therapeutic and pathological manipulations, and the pressures in the three intracranial compartments were compared. Changes in ICP appeared to be reflected simultaneously and equally in all three compartments. Furthermore, changes in ICP secondary to a unilateral mass lesion were identical in both supratentorial parenchymal compartments when measured simultaneously. It is concluded that the fiberoptic device is an accurate and reliable system for ICP monitoring; the pressures recorded in the subdural, intraparenchymal, and intraventricular compartments paralleled each other in all of the physiological and pathological states tested. Although the drift associated with this device is less than that reported for previously available systems, its maximal cumulative drift over a 5-day period of +/- 6 mm Hg is significant. Since the fiberoptic device cannot be recalibrated in situ, it is suggested that the device be replaced if monitoring is to be continued for periods longer than 5 days.

Fiberoptic intracranial pressure monitoring in rats

An adaptation of a fiberoptic intracranial pressure monitoring system for clinical use is described. The method allows easy and reliable acute and chronic intracranial pressure registration in anesthetized as well as conscious rats. The disposable fiberoptic probes, originally designed for human use, can be re-used limitlessly. The fiberoptic method is compared with conventional monitoring procedures under different experimental conditions. The validity of intraparenchymal and epidural measurements is discussed. The importance of chronic intracranial pressure registration in conscious laboratory animals is stressed.

The use of a fiberoptic intracranial pressure monitor in clinical practice.

Four years of clinical experience with a fiberoptic intracranial pressure monitor are presented. One hundred forty patients were monitored, of whom 80 had increased intracranial pressure. Of the patients with nontraumatic intracerebral hematoma and subarachnoid hemorrhage, 100% had increased pressure. Forty-seven of 69 patients with head injuries had elevated pressure; of these, 28 had pressure significant enough to require therapy. Both the patients with head injuries and those with nontraumatic hemorrhage were more effectively treated by using the results of pressure monitoring to determine when therapy was required and to indicate the response of the patient to that therapy. Despite the evidence, monitoring of intracranial pressure is not routine due to a lack of acceptance and effectiveness. To overcome such problems, a system must meet the criteria of ease of insertion, reliability, and lack of complications. These criteria are fulfilled by the fiberoptic system presented.

The use of a fiberoptic intracranial pressure monitor in clinical practice

The use of a fiberoptic intracranial pressure monitor in clinical practice