Characterization of Shape Differences Among ICP Pulses Predicts Outcome of External Ventricular Drainage Weaning Trial.
Characterization of Shape Differences Among ICP Pulses Predicts Outcome of External Ventricular Drainage Weaning Trial.
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DOI：
10.1007/s12028-016-0268-4
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发表时间：
2016-12
影响因子：
3.5
通讯作者：
Hu X
中科院分区：
文献类型：
--
作者：
Arroyo-Palacios J;Rudz M;Fidler R;Smith W;Ko N;Park S;Bai Y;Hu X
脑室外引流管（EVD）广泛用于治疗动脉瘤性蛛网膜下腔出血（aSAH）患者的颅内压（ICP）和脑积水。在使用数天后，决定移除EVD或用分流管替换，包括EVD撤机和CT成像以观察心室大小和临床状态。这种做法可能会导致住院时间延长，额外的辐射暴露，以及颅内压升高引起的神经损伤。本研究旨在应用经验证的ICP脉搏形态聚类分析（MOCAIP）算法检测脉搏波形的特征，以区分EVD脱机期间完整的CSF循环系统与异常的CSF循环系统。我们对2013年3月至2014年8月期间在我院住院的50例aSAH患者进行了回顾性研究，这些患者报告了撤机试验。通过审查临床记录和术前/术后脑成像结果，确定32例患者通过了脱机试验，18例患者未通过试验。将MOCAIP算法应用于ICP信号以形成一系列无伪影的优势脉冲。最后，识别具有相似平均ICP的脉冲，并在4小时移动窗口中计算脉冲间的幅度、欧几里得距离和测地线距离。虽然平均ICP的传统测量无法区分两组患者，但拟定的幅度和形态脉冲间测量存在显著差异（p≤0.004）。此外，受试者操作特征（ROC）分析显示其可用于预测EVD脱机试验的结局（AUC=0.85，p<0.001）。CSF系统受损的患者表现出更大的平均值和变异性的脉冲间距离，表明频繁的变化的形态脉冲。该技术可提供一种快速确定患者是否需要放置分流管或仅需移除EVD的方法。
External ventricular drains (EVD) are widely used to manage intracranial pressure (ICP) and hydrocephalus for aneurysmal subarachnoid hemorrhage (aSAH) patients. After days of use, a decision is made to remove the EVD or replace it with a shunt, involving EVD weaning and CT imaging to observe ventricular size and clinical status. This practice may lead to prolonged hospital stay, extra radiation exposure, and neurological insult due to ICP elevation. This study aims to apply a validated morphological clustering analysis of ICP pulse (MOCAIP) algorithm to detect signatures from the pulse waveform to differentiate an intact CSF circulatory system from an abnormal one during EVD weaning. We performed a retrospective study with 50 aSAH patients with reported weaning trial admitted to our institution between 03/2013 and 08/2014. By reviewing clinical notes and pre/post brain imaging results, 32 patients were determined as having passed the weaning trial and 18 patients as having failed the trial. MOCAIP algorithm was applied to ICP signals to form a series of artifact-free dominant pulses. Finally, pulses with similar mean ICP were identified and amplitude, Euclidean and geodesic inter-pulse distances calculated in a 4-hour moving window. While the traditional measure of mean ICP failed to differentiate the two groups of patients, the proposed amplitude and morphological inter-pulse measures presented significant differences (p≤0.004). Moreover, receiver operating characteristic (ROC) analyses showed their usability to predict the outcome of the EVD weaning trial (AUC=0.85, p<0.001). Patients with an impaired CSF system showed a larger mean and variability of inter-pulse distances, indicating frequent changes on the morphology of pulses. This technique may provide a method to rapidly determine if patients will need placement of a shunt or can simply have the EVD removed.
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DOI：
10.1109/tbme.2008.2008636
发表时间：
2009-03
期刊：
IEEE transactions on bio-medical engineering
影响因子：
--
作者：
Hu X;Xu P;Scalzo F;Vespa P;Bergsneider M
通讯作者：
Bergsneider M
影响因子：
4.1
作者：
Klopfenstein, JD;Kim, LJ;Spetzler, RF
通讯作者：
Spetzler, RF
影响因子：
3.3
作者：
Hamilton, Robert;Baldwin, Kevin;Bergsneider, Marvin
通讯作者：
Bergsneider, Marvin
DOI：
10.1111/j.2517-6161.1995.tb02031.x
发表时间：
1995-01-01
影响因子：
5.8
作者：
BENJAMINI, Y;HOCHBERG, Y
通讯作者：
HOCHBERG, Y
影响因子：
8.3
作者：
Connolly, E. Sander, Jr.;Rabinstein, Alejandro A.;Vespa, Paul
通讯作者：
Vespa, Paul