Noninvasive Determination of Intracranial Pressure in Pediatric Patients

儿科患者颅内压的无创测定

• 批准号: 8702340
• 负责人: Thomas Heldt
• 金额: $ 24.45万
• 依托单位: MASSACHUSETTS INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-15 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8702340
• 关键词: Adolescent; Adult; Affect; Algorithms; Anesthesiology; Archives; Biomedical Engineering; Biomedical Research; Blood Flow Velocity; Blood Pressure; Boston; Brain; Calibration; Caring; Catheterization; Catheters; Cause of Death; Cephalic; Cerebrospinal Fluid; Cerebrovascular Circulation; Cerebrovascular Physiology; Cerebrum; Characteristics; Child; Childhood; Clinical; Clinical Research; Coma; Communities; Critical Care; Data; Databases; Development; Diagnosis; Diagnostic; Ensure; Fingers; Glasgow Coma Scale; Goals; Hydrocephalus; Injury; Institutes; Intracranial Pressure; Massachusetts; Measurement; Measures; Methods; Modeling; Monitor; Morbidity - disease rate; Morphologic artifacts; Nature; Neurologic; Neurological outcome; Neurology; Neurosurgeon; Noise; Operating Rooms; Operative Surgical Procedures; Outcome; Patients; Pediatric Hospitals; Penetration; Performance; Physiological; Physiology; Procedures; Records; Research; Research Project Grants; Resources; Risk; Shunt Device; Signal Transduction; System; Technology; Testing; Therapeutic; Time; Titrations; Traumatic Brain Injury; Validation; Ventricular; Work; base; cerebrovascular; clinical care; clinical practice; cranium; design; disability; experience; improved; mathematical model; minimally invasive; mortality; neurosurgery; novel strategies; patient population; pressure; prospective; public health relevance; radial artery; statistics; success; validation studies

DESCRIPTION (provided by applicant): The overall goal of this application is to assess the feasibility of a noninvasive approach to patient-specific determination and monitoring of intracranial pressure (ICP) in a pediatric patient population. The proposed research is an important first step towards making this cardinal 'cranial vital sign' available in a much broader pediatric patient population than is currently possible. The PI is an expert in biomedical engineering, especially the modeling and identification of physiological systems, with highly relevant prior research experience. He has assembled a first-class team consisting of Dr. Robert Tasker, Chair of Neurocritical Care, Dr. Shenandoah Robinson, pediatric neurosurgeon, and Dr. Kush Kapur, Senior Biostatistician, all at Boston Children's Hospital (BCH). The combined resources available at the Computational Physiology & Clinical Inference Group at the Massachusetts Institute of Technology and the Departments of Neurology, Anesthesiology, and Neurosurgery at BCH ensure optimal support for this research project. ICP is important to track in a variety of conditions affecting the brain. Its measurement, however, requires surgical penetration of the skull and placement of a pressure-sensitive probe in the brain parenchyma, or insertion of a catheter into the ventricular or extra- ventricular cerebrospinal fluid spaces. This invasiveness and the associated risks cause ICP measurements in current clinical practice to only be made in a small subset of patients whose diagnosis and treatment could benefit from knowing ICP. The gap is particularly apparent for pediatric patients, in whom TBI is the leading cause of death and disability, but where the threshold for invasive ICP monitoring is severe injury and coma, defined as Glasgow Coma Scale score less than 9. Consequently, ICP measurements are limited to specialized care facilities and are performed in only those patients for whom the risks of the procedures are outweighed by the overriding need to know ICP for diagnostic or therapeutic purposes. To support the development of a robust, accurate, and precise method for determining ICP entirely noninvasively in children, we will collect (and make available to the research community) ICP and noninvasive arterial blood pressure (nABP) and cerebral blood flow velocity (CBFV) waveform signals in pediatric patients undergoing invasive ICP measurements (Aim 1) for treatment of severe traumatic brain injury and placement of cerebral shunts for hydrocephalus. We will also adapt a previously developed approach to minimally invasive ICP determination in adults to the characteristics of the nABP and CBFV signals and the cerebrovascular dynamics in pediatric patients. Success with these aims will allow us to quantify the preliminary performance of an entirely noninvasive approach to continuous determination of absolute ICP in children and young adolescents, which will enable us to design prospective, multicenter validation studies. A prospectively validated approach to noninvasive determination of absolute ICP would significantly improve neurologic, neurosurgical, and neurocritical care in children.

描述（由申请人提供）：本申请的总体目标是评估在儿科患者人群中采用无创方法确定和监测患者特定颅内压（ICP）的可行性。拟议的研究是重要的第一步，使这一基本的“颅生命体征”可在更广泛的儿科患者群体比目前可能的。PI是生物医学工程方面的专家，特别是生理系统的建模和识别，具有高度相关的先前研究经验。他组建了一支一流的团队，由神经重症监护主席Robert Tasker博士、儿科神经外科医生Shenandoah罗宾逊博士和高级生物统计学家Kush Kapur博士组成，他们都在波士顿儿童医院（BCH）。马萨诸塞州理工学院的计算生理学和临床推理组以及BCH的神经病学、麻醉学和神经外科学系的综合资源确保了对该研究项目的最佳支持。ICP对于跟踪影响大脑的各种情况非常重要。然而，其测量需要外科手术穿透颅骨并在脑实质中放置压敏探针，或将导管插入脑室或脑室外脑脊液空间。这 侵入性和相关的风险导致在当前的临床实践中ICP测量仅在一小部分患者中进行，这些患者的诊断和治疗可以受益于了解ICP。差距在儿科患者中尤其明显，TBI是死亡和残疾的主要原因，但侵入性ICP监测的阈值是严重损伤和昏迷，定义为格拉斯哥昏迷量表评分小于9。因此，ICP测量仅限于专业护理机构，并且仅在那些出于诊断或治疗目的而需要了解ICP的风险超过手术风险的患者中进行。为了支持开发一种完全无创地测定儿童ICP的稳健、准确和精确的方法，我们将收集（并向研究界提供）接受有创ICP测量的儿科患者的ICP和无创动脉血压（nABP）和脑血流速度（CBFV）波形信号（目标1）用于治疗严重创伤性脑损伤和脑积水的脑分流器放置。我们还将调整先前开发的方法，以微创颅内压测定成人的nABP和CBFV信号的特点和脑血管动力学在儿科患者。这些目标的成功将使我们能够量化一种完全无创方法的初步性能，以连续测定儿童和青少年的绝对ICP，这将使我们能够设计前瞻性，多中心验证研究。一种前瞻性验证的无创测定绝对颅内压的方法将显著改善儿童的神经病学、神经外科和神经重症监护。