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Noninvasive Determination of Intracranial Pressure in Pediatric Patients

儿科患者颅内压的无创测定

基本信息

批准号：
8887391
负责人：
Thomas Heldt
金额：
$ 20.03万
依托单位：
MASSACHUSETTS INSTITUTE OF TECHNOLOGY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-15 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8887391
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 Health 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 pediatric patients pressure prospective radial artery statistics success validation studies

项目摘要

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一种无创方法在儿科患者群体中用于患者特异性测定和监测颅内压（ICP）的可行性。拟议的研究是重要的第一步，使这一主要的“颅生命体征”比目前可能的更广泛的儿科患者群体。该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。他在波士顿儿童医院（BCH）组建了一个一流的团队，由神经重症监护主席Robert Tasker博士、儿科神经外科医生Shenandoah Robinson博士和高级生物统计学家Kush Kapur博士组成。麻省理工学院计算生理学和临床推断组以及BCH神经内科、麻醉科和神经外科的综合资源确保了对该研究项目的最佳支持。在影响大脑的各种情况下追踪ICP是很重要的。然而，测量它需要手术穿透颅骨并在脑实质中放置压力敏感探头，或将导管插入脑室或脑室外脑脊液间隙。这