A Spectral Approach to Model-Based Noninvasive Intracranial Pressure Estimation.
A Spectral Approach to Model-Based Noninvasive Intracranial Pressure Estimation.
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DOI：
10.1109/jbhi.2019.2961403
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发表时间：
2020-08
影响因子：
7.7
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中科院分区：
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颅内压（ICP）通常为5至15 mmHg。ICP升高是神经损伤的重要临床指标，因此在几种神经系统疾病中常规监测ICP，以指导诊断和治疗决策。目前用于ICP监测的测量模式是高度侵入性的，在很大程度上限制了对危重患者的测量。一个准确的非侵入性方法来估计颅内压将大大扩大池的病人，可以受益于这一颅生命体征。本研究提出了一种基于模型的颅内压（ICP）估计的频谱方法，从动脉血压（ABP）和脑血流速度（CBFV）的测量。该模型捕获ABP、CBFV和ICP波形之间的关系，并利用脑血管系统的二阶模型来估计ICP。该估计方法在两个独立的临床数据集上进行了验证，一个数据集记录了13名儿科患者，持续时间约为7小时，另一个数据集记录了5名成人患者，持续时间为1小时48分钟。在估计儿童和成人数据的平均ICP（范围为1.3 mmHg至24.8 mmHg）时，该算法的准确度（平均误差）分别为0.4 mmHg和−1.5 mmHg，精密度（误差的标准差）分别为5.1 mmHg和4.3 mmHg。这些结果与之前的结果相当，并且在临床相关范围内。此外，在逐搏基础上估计ICP脉压的准确度和精密度分别为1.3 mmHg和2.9 mmHg。这些贡献朝着实现在临床环境中实施实时非侵入性ICP估计模态的目标迈出了一步，以实现准确的临床决策，同时克服侵入性ICP模态的缺点。
Intracranial pressure (ICP) normally ranges from 5 to 15 mmHg. Elevation in ICP is an important clinical indicator of neurological injury, and ICP is therefore monitored routinely in several neurological conditions to guide diagnosis and treatment decisions. Current measurement modalities for ICP monitoring are highly invasive, largely limiting the measurement to critically ill patients. An accurate noninvasive method to estimate ICP would dramatically expand the pool of patients that could benefit from this cranial vital sign. This work presents a spectral approach to model-based ICP estimation from arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV) measurements. The model captures the relationship between the ABP, CBFV and ICP waveforms and utilizes a second-order model of the cerebral vasculature to estimate ICP. The estimation approach was validated on two separate clinical datasets, one recorded from thirteen pediatric patients with a duration of around seven hours, and the other recorded from five adult patients, one hour and 48 minutes in duration. The algorithm was shown to have an accuracy (mean error) of 0.4 mmHg and −1.5 mmHg, and a precision (standard deviation of the error) of 5.1 mmHg and 4.3 mmHg, in estimating mean ICP (range of 1.3 mmHg to 24.8 mmHg) on the pediatric and adult data, respectively. These results are comparable to previous results and within the clinically relevant range. Additionally, the accuracy and precision in estimating the pulse pressure of ICP on a beat-by-beat basis were found to be 1.3 mmHg and 2.9 mmHg respectively. These contributions take a step towards realizing the goal of implementing a real-time noninvasive ICP estimation modality in a clinical setting, to enable accurate clinical-decision making while overcoming the drawbacks of the invasive ICP modalities.