Prospective Study on Noninvasive Assessment of Intracranial Pressure in Traumatic Brain-Injured Patients: Comparison of Four Methods
Prospective Study on Noninvasive Assessment of Intracranial Pressure in Traumatic Brain-Injured Patients: Comparison of Four Methods
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DOI：
10.1089/neu.2015.4134
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发表时间：
2016-04-15
影响因子：
4.2
通讯作者：
Czosnyka, Marek
中科院分区：
文献类型：
--
作者：
Cardim, Danilo;Robba, Chiara;Czosnyka, Marek
颅内压升高（ICP）可能发生在许多疾病中，因此能够无创地测量它将是有用的。来自经颅多普勒（TCD）的流速信号已被用于估计ICP;然而，这些方法的相对准确性尚不清楚。本研究旨在比较四种先前描述的基于TCD的方法与直接测量的颅内压在一个前瞻性队列的创伤性脑损伤患者。使用以下方法获得无创ICP（nICP）：1）基于TCD和动脉血压（nICP_BB）之间相互作用的数学“黑箱”模型; 2）基于舒张期流速（nICP_FVd）; 3）基于临界闭合压（nICP_CrCP）;以及4）基于TCD衍生的脉动指数（nICP_PI）。在时域中，对于包括ICP大于7 mm Hg的自发变化的记录，nICP_PI显示出与测量的ICP的最佳相关性（R = 0.61）。将每个TCD记录作为独立事件考虑，nICP_BB通常显示为测量的ICP的最佳估计值（R = 0.39; p < 0.05; 95%置信区间[CI] = 9.94 mm Hg;曲线下面积[AUC] = 0.66; p < 0.05）。对于nICP_FVd，尽管其相关系数与nICP_BB相似，AUC略好（0.70; p < 0.05），但其预测ICP（14.62 mm Hg）的95% CI更大。nICP_CrCP呈现中等相关系数（R = 0.35; p < 0.05）和与nICP_BB相似的95% CI（9.19 mm Hg），但无法区分正常和升高的ICP（AUC = 0.64; p > 0.05）。nICP_PI与使用上述任何统计指标测量的ICP无关。我们还引入了一种基于三种方法（nICP_BB、nICP_FVd和nICP_CrCP）平均值的新估计量（nICP_Av），其总体上呈现了改进的统计指标（R = 0.47; p < 0.05; 95% CI = 9.17 mm Hg; AUC = 0.73; p < 0.05）。nICP_PI似乎最准确地反映了ICP随时间的变化。nICP_BB是ICP“作为一个数字的最佳估计。“nICP_Av证明可以提高测量的ICP估计的准确性。
Elevation of intracranial pressure (ICP) may occur in many diseases, and therefore the ability to measure it noninvasively would be useful. Flow velocity signals from transcranial Doppler (TCD) have been used to estimate ICP; however, the relative accuracy of these methods is unclear. This study aimed to compare four previously described TCD-based methods with directly measured ICP in a prospective cohort of traumatic brain-injured patients. Noninvasive ICP (nICP) was obtained using the following methods: 1) a mathematical "black-box" model based on interaction between TCD and arterial blood pressure (nICP_BB); 2) based on diastolic flow velocity (nICP_FVd); 3) based on critical closing pressure (nICP_CrCP); and 4) based on TCD-derived pulsatility index (nICP_PI). In time domain, for recordings including spontaneous changes in ICP greater than 7 mm Hg, nICP_PI showed the best correlation with measured ICP (R = 0.61). Considering every TCD recording as an independent event, nICP_BB generally showed to be the best estimator of measured ICP (R = 0.39; p < 0.05; 95% confidence interval [CI] = 9.94 mm Hg; area under the curve [AUC] = 0.66; p < 0.05). For nICP_FVd, although it presented similar correlation coefficient to nICP_BB and marginally better AUC (0.70; p < 0.05), it demonstrated a greater 95% CI for prediction of ICP (14.62 mm Hg). nICP_CrCP presented a moderate correlation coefficient (R = 0.35; p < 0.05) and similar 95% CI to nICP_BB (9.19 mm Hg), but failed to distinguish between normal and raised ICP (AUC = 0.64; p > 0.05). nICP_PI was not related to measured ICP using any of the above statistical indicators. We also introduced a new estimator (nICP_Av) based on the average of three methods (nICP_BB, nICP_FVd, and nICP_CrCP), which overall presented improved statistical indicators (R = 0.47; p < 0.05; 95% CI = 9.17 mm Hg; AUC = 0.73; p < 0.05). nICP_PI appeared to reflect changes in ICP in time most accurately. nICP_BB was the best estimator for ICP "as a number." nICP_Av demonstrated to improve the accuracy of measured ICP estimation.