Cabella, Brenno

Cardim, Danilo

Czosnyka, Marek

Czosnyka, Zofia Helena

Donnelly, Joseph

Garnett, Matthew

Pickard, John D

Robba, Chiara

Fluids and Barriers of the CNS

English

PubMed

Apollo (Cambridge)

POSTER PRESENTATION Open AccessNon-invasive assessment of ICP during infusiontest using Transcranial Doppler UltrasonographyDanilo Cardim1, Brenno Cabella1, Joseph Donnelly1, Chiara Robba2, Marek Czosnyka1, Matthew Garnett1,John D Pickard1, Zofia Helena Czosnyka1*From Hydrocephalus 2015Banff, Canada. 18-21 September 2015BackgroundTranscranial Doppler (TCD) based methods have beenused to estimate ICP noninvasively (nICP), however theirrelative accuracy varies between different types of intracra-nial hypertension: vasogenic, CSF circulatory or secondaryto brain volumetric changes (oedema, contusion, hema-toma, etc). This study aimed to compare four nICP meth-ods in a prospective cohort of hydrocephalus patientswhose CSF dynamics was investigated using infusion testsinvolving controllable test-rise of ICP.MethodsFV, ICP and non-invasive ABP were recorded in 53patients diagnosed for hydrocephalus. nICP methods werebased on: I) interaction between FV and ABP using black-box model (nICP_BB); II) diastolic FV (nICP_FVd); III)critical closing pressure (nICP_CrCP) and IV) TCD-derived pulsatility index (nICP_PI). Correlation betweenrise in ICP (ΔICP) and ΔnICP and averaged correlationsfor changes in time between ICP and nICP during infusiontest were investigated.ResultsAll nICP formulas overestimated ICP at baseline(p<0.005): nICP_BB 10.76 (15.08-7.30); nICP_FVd 16.97(22.56- 11.64); nICP_CrCP 18.34 (20.38-14.89); nICP_PI16.57 (17.46-16.06). At plateau of ICP during infusion test,only nICP_BB and nICP_PI presented significant differ-ence from ICP. From baseline to plateau, all nICPs estima-tors increased significantly (paired t-test, p<0.05).Correlations between ΔICP and ΔnICP were better repre-sented by ICPn_PI and ICPn_BB: 0.45 and 0.30 (p<0.05).nICP_FVd and nICP_CrCP presented non-significantcorrelations: -0.17 (p=0.21), 0.21 (p=0.13). For changes inICP during individual infusion test ICPn_PI, ICPn_BB andICPn_FVd presented similar correlations with ICP:0.39±0.40, 0.39±0.43 and 0.35±0.41 respectively.ICPn_CrCP presented a weaker correlation (R=0.29±0.24).In those cases where changes of ICP related to vasogenicfluctuations (plateu wabes, B waves) overlapped riserelated to CSF infusion, time- correlation between realand estimated ICP seemed to be remarkably better.ConclusionsOut of the 4 methods, nICP_PI was the one with best per-formance for predicting changes in ΔICP during infusiontest, followed by nICP_BB. nICP_FVd and nICP_CrCPshowed unreliable correlations. Changes of ICP observedduring the test were expressed by nICP values with only amoderate correlations. Vasogenic components of ICPseemed to be easier to estimate with TCD, than compo-nent related to increased CSF circulation.Authors’ details1Neurosurgery, University of Cambridge, UK. 2Dept of Anesthesiology,University of Genoa, Italy.Published: 18 September 2015doi:10.1186/2045-8118-12-S1-P6Cite this article as: Cardim et al.: Non-invasive assessment of ICP duringinfusion test using Transcranial Doppler Ultrasonography. Fluids andBarriers of the CNS 2015 12(Suppl 1):P6.* Correspondence: zc200@medschl.cam.ac.uk1Neurosurgery, University of Cambridge, UKFull list of author information is available at the end of the articleCardim et al. Fluids and Barriers of the CNS 2015, 12(Suppl 1):P6http://www.fluidsbarrierscns.com/content/12/S1/P6FLUIDS AND BARRIERS OF THE CNS© 2015 Cardim et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Non-invasive assessment of ICP during infusion test using Transcranial Doppler Ultrasonography

http://dx.doi.org/10.1186/2045-8118-12-S1-P6

Non-invasive assessment of ICP during infusion test using Transcranial Doppler Ultrasonography

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