Predicting short-term outcomes in brain-injured patients: a comprehensive approach with transcranial Doppler and intracranial compliance assessment

• Published in: Journal of clinical monitoring and computing 2024-12, Vol.38 (6), p.1237-1247
• Main Authors: Brasil, Sérgio, Cardim, Danilo, Caldas, Juliana, Robba, Chiara, Taccone, Fabio Silvio, de-Lima-Oliveira, Marcelo, Yoshikawa, Márcia Harumy, Malbouisson, Luiz Marcelo Sá, Paiva, Wellingson S.
• Format: Article
• Language: English
• Subjects: Abnormalities; Adult; Aged; Anesthesiology; Area Under Curve; Boron carbide; Brain; Brain - diagnostic imaging; Brain Injuries - diagnostic imaging; Brain Injuries - mortality; Brain Injuries, Traumatic - diagnostic imaging; Brain Injuries, Traumatic - mortality; Cerebrovascular Circulation; Critical Care Medicine; Data collection; Death; Deformation; Female; Head injuries; Health Sciences; Hemodynamics; Hemorrhage; Humans; Hypertension; Intensive; Intracranial Hypertension; Intracranial Pressure; Male; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Physiologic - methods; Original Research; Parameter estimation; Parameter identification; Predictive Value of Tests; Prognosis; Prospective Studies; ROC Curve; Statistics for Life Sciences; Traumatic brain injury; Treatment Outcome; Ultrasonography, Doppler, Transcranial - methods
• ISSN: 1387-1307; 1573-2614; 1573-2614
• DOI: 10.1007/s10877-024-01181-y

Neurocritical patients frequently exhibit abnormalities in cerebral hemodynamics (CH) and/or intracranial compliance (ICC), all of which significantly impact their clinical outcomes. Transcranial Doppler (TCD) and the cranial micro-deformation sensor (B4C) are valuable techniques for assessing CH and ICC, respectively. However, there is a scarcity of data regarding the predictive value of these techniques in determining patient outcomes. We prospectively included neurocritical patients undergoing intracranial pressure (ICP) monitoring within the first 5 days of hospital admission for TCD and B4C assessments. Comprehensive clinical data were collected alongside parameters obtained from TCD (including the estimated ICP [eICP] and estimated cerebral perfusion pressure [eCPP]) and B4C (measured as the P2/P1 ratio). These parameters were evaluated individually as well as in combination. The short-term outcomes (STO) of interest were the therapy intensity levels (TIL) for ICP management recommended by the Seattle International Brain Injury Consensus Conference, as TIL 0 (STO 1), TIL 1–3 (STO 2) and death (STO 3), at the seventh day after last data collection. The dataset was randomly separated in test and training samples, area under the curve (AUC) was used to represent the noninvasive techniques ability on the STO prediction and association with ICP. A total of 98 patients were included, with 67% having experienced severe traumatic brain injury and 15% subarachnoid hemorrhage, whilst the remaining patients had ischemic or hemorrhagic stroke. ICP, P2/P1, and eCPP demonstrated the highest ability to predict early mortality ( p  = 0.02, p  = 0.02, and p  = 0.006, respectively). P2/P1 was the only parameter significant for the prediction of STO 1 ( p  = 0.03). Combining B4C and TCD parameters, the highest AUC was 0.85 to predict death (STO 3), using P2/P1 + eCPP, whereas AUC was 0.72 to identify ICP > 20 mmHg using P2/P1 + eICP. The combined noninvasive neuromonitoring approach using eCPP and P2/P1 ratio demonstrated improved performance in predicting outcomes during the early phase after acute brain injury. The correlation with intracranial hypertension was moderate, by means of eICP and P2/P1 ratio. These results support the need for interpretation of this information in the ICU and warrant further investigations for the definition of therapy strategies using ancillary tests. Trial registration NCT03144219, Registered 01 May 2017, https://www.clinicaltrials.gov/