Magdalena Kasprowicz, Agnieszka Kazimierska, Marta Hendler, Danilo Cardim, Zofia Czosnyka, Marek Czosnyka, Wellingson Paiva, Sergio Brasil
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引用次数: 0
Abstract
Background: Pulse shape index (PSI) is a novel artificial intelligence-supported parameter that evaluates the pressure-volume compensatory reserve of the craniospinal system through intracranial pressure (ICP) pulse waveform classification. This study assessed the agreement between PSI derived from invasive ICP monitoring (PSIICP) and noninvasive brain4care (B4C) sensor signal (PSIB4C) and investigated the influence of cranial integrity, age, and internal jugular vein (IJV) compression on PSI values.
Methods: Simultaneous ICP and B4C monitoring was performed in 47 adult patients ( age: 43 (30) years) before and during IJV compression. Patients were grouped by cranial integrity: intact skull bone (n = 17), large skull fractures or craniotomies (n = 17), and craniectomies (n = 13). Pulse waveforms were automatically classified into four classes (from 1 = normal to 4 = pathological) by a neural network, and PSI was calculated as the weighted average of class numbers. Values are presented as median (interquartile range).
Results: Bland-Altman analysis demonstrated good agreement between PSIICP and PSIB4C, with approximately 6% outliers. PSI was significantly higher in patients who underwent craniectomy compared with those with intact skulls (PSIICP: 3.5 (0.8) vs. 2.0 (1.2) arbitrary units, p < 0.002; PSIB4C: 3.0 (0.4) vs. 2.0 (0.6) arbitrary units, p < 0.005) or those with craniotomies or large fractures (PSIICP: 3.5 (0.8) vs. 2.0 (2.1) arbitrary units, p < 0.05; PSIB4C: 3.0 (0.4) vs. 2.0 (2.2) arbitrary units, p < 0.05). IJV compression did not affect PSI. Both PSIICP (rs = 0.35, p < 0.02) and PSIB4C (rs = 0.37, p = 0.01) correlated with age.
Conclusions: This study supports the B4C signal's capability to noninvasively reflect ICP waveform morphology via PSI, offering a promising monitoring alternative. PSI appears to be influenced by age and craniectomy but not by a slight, sudden ICP change induced by IJV compression.
期刊介绍：
Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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