Non-Invasive Carotid Artery Measurements for Continuous Intracranial Pressure Monitoring

项目总结 连续颅内压监测是危重神经科的重要监护手段 为患者提供 对疾病严重程度的批判性见解指导医疗管理 。然而， 比较方案 监测需要高度侵入性的手术，会招致颅内出血和感染的风险。 因此，颅内压监测的临床适应症是一个有争议的话题，在创伤性脑损伤中高达50%。 符合颅内压监测仪推荐标准的患者从未接受过。22此外，近一半的患者 住进神经重症监护病房(Neuro-ICU)但没有颅内压监测仪的患者后来发展得更高 ICP.1不幸的是，即使是符合条件的患者，也只能在神经ICU期间接受颅内压监测。之后 足够的恢复，即使它们仍然处于高电平，也会被转移到没有监视器的降压单元 有发生ICP升高和潜在致命性脑突出症的风险。因此，有一个明显的未得到满足的需求。 采用非侵入性方法进行持续的颅内压监测。 我们建议开发一种非侵入性传感系统，通过将心跳与颅内压相关联来持续监测颅内压。 要跳动颈动脉血压至颅内压。 先前的研究已经证明，在中心动脉检测到的波形 颈动脉的颅外部分与颅内压波形非常相似。3-10在我们之前的工作中，我们 开发高灵敏度的保形传感器，能够以最小的成本测量颈动脉血压波形 拍打压力。 36，37瓦 我们还演示了一种新的压力估计算法，该算法可以 外科和ICU患者高精度的桡动脉血压测量。 13通过结合我们高度敏感的 带有我们的通用压力估计算法的传感器， 我们假设我们可以非侵入性地 通过开发参数估计模型来关联传感器的颈动脉血压来持续监测颅内压 使用神经ICU患者的录音测量用于训练和验证的颅内压波形 。 研究 也证明了其他由颅内压波形衍生的指数用于评估颅内的临床实用价值。 依从性和预测患者结果。14-18由于颈动脉血压的形态相似 我们假设这些波形特征也可以应用于我们的颈动脉血压 测量和传感器派生的ICP估计，以获得对患者神经状态的独特见解，可以 帮助医疗决策。T 这个项目的发现有可能成为未来的基础。 颈动脉血压波形特征作为颅内压替代指标的研究。此外，我 F 成功后，我们提出的非侵入性、连续的颅内压监测仪不仅有可能增强 对更广泛的患者进行神经学监测，但也创造了现有的 临床方案有利于更积极主动的颅内压监测。

PROJECT SUMMARY Continuous intracranial pressure (ICP) monitoring is an important surveillance tool for critically ill neurologic patients that provides critical insights on disease severity for guiding medical management . However, ICP monitoring requires a highly invasive procedures that incurs risks for intracranial hemorrhage and infection.24–28 Thus, the clinical indications for ICP monitoring are a topic of debate and up to 50% of traumatic brain injury patients who fulfill recommendation criteria for an ICP monitor never receive it.22 Moreover, nearly half of patients admitted to the Neuro-Intensive Care Unit (Neuro-ICU) without an ICP monitor go on to later develop elevated ICP.1 Unfortunately, even eligible patients are only provided ICP monitoring while in the Neuro-ICU. After adequate recovery, they are transferred to a step-down unit without a monitor even though they are still at high risk for developing elevated ICPs and potentially fatal brain herniation. Therefore, there is a clear unmet need for a non-invasive approach to continuous ICP monitoring. We propose to develop a non-invasive sensing system to continuously monitor ICP by correlating beat- to-beat carotid artery BP to ICP. Prior studies have demonstrated that central aortic waveforms detected at the extracranial portion of the carotid artery closely resemble ICP waveforms.3-10 In our previous work, we developed highly sensitivity conformal sensors capable of measuring carotid artery BP waveforms with minimal applanation pressure. 36,37 W e have also demonstrated a novel pressure estimation algorithm that can sustain high accuracy radial artery BP measurements in surgical and ICU patients. 13 By combining our highly sensitive sensors with our generalizable pressure estimation algorithm, we hypothesize that we can non-invasively and continuously monitor ICP by developing a parameter estimation model to correlate our sensor's carotid BP measurements with ICP waveforms using recordings from Neuro-ICU patients for training and validation . Studies have also demonstrated the clinical utility of other ICP waveform-derived indices for assessing intracranial compliance and prognosticating patient outcomes.14–18 Due to the morphological similarity between carotid BP and ICP waveforms, we hypothesize that these waveform features can also be applied to our carotid BP measurements and sensor-derived ICP estimations to gain unique insights on patient neurologic status that can aid medical decision-making. T he findings of this project have the potential to form the basis for future investigations on utilizing the waveform features of carotid BP as a proxy measure of ICP. Moreover, i f successful, our proposed non-invasive, continuous ICP monitor has the potential to not only enhance neurologic monitoring across a broader range of patients, but also create a paradigm shift in existing clinical protocols in favor of more proactive ICP surveillance.