Luca Bastia, Roberta Garberi, Lorenzo Querci, Cristiana Cipolla, Francesco Curto, Emanuele Rezoagli, Roberto Fumagalli, Arturo Chieregato
{"title":"Dynamic inflation prevents and standardized lung recruitment reverts volume loss associated with percutaneous tracheostomy during volume control ventilation: results from a Neuro-ICU population.","authors":"Luca Bastia, Roberta Garberi, Lorenzo Querci, Cristiana Cipolla, Francesco Curto, Emanuele Rezoagli, Roberto Fumagalli, Arturo Chieregato","doi":"10.1007/s10877-024-01174-x","DOIUrl":"10.1007/s10877-024-01174-x","url":null,"abstract":"<p><p>To determine how percutaneous tracheostomy (PT) impacts on respiratory system compliance (C<sub>rs</sub>) and end-expiratory lung volume (EELV) during volume control ventilation and to test whether a recruitment maneuver (RM) at the end of PT may reverse lung derecruitment. This is a single center, prospective, applied physiology study. 25 patients with acute brain injury who underwent PT were studied. Patients were ventilated in volume control ventilation. Electrical impedance tomography (EIT) monitoring and respiratory mechanics measurements were performed in three steps: (a) baseline, (b) after PT, and (c) after a standardized RM (10 sighs of 30 cmH<sub>2</sub>O lasting 3 s each within 1 min). End-expiratory lung impedance (EELI) was used as a surrogate of EELV. PT determined a significant EELI loss (mean reduction of 432 arbitrary units p = 0.049) leading to a reduction in C<sub>rs</sub> (55 ± 13 vs. 62 ± 13 mL/cmH<sub>2</sub>O; p < 0.001) as compared to baseline. RM was able to revert EELI loss and restore C<sub>rs</sub> (68 ± 15 vs. 55 ± 13 mL/cmH<sub>2</sub>O; p < 0.001). In a subgroup of patients (N = 8, 31%), we observed a gradual but progressive increase in EELI. In this subgroup, patients did not experience a decrease of C<sub>rs</sub> after PT as compared to patients without dynamic inflation. Dynamic inflation did not cause hemodynamic impairment nor raising of intracranial pressure. We propose a novel and explorative hyperinflation risk index (HRI) formula. Volume control ventilation did not prevent the PT-induced lung derecruitment. RM could restore the baseline lung volume and mechanics. Dynamic inflation is common during PT, it can be monitored real-time by EIT and anticipated by HRI. The presence of dynamic inflation during PT may prevent lung derecruitment.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1387-1396"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heejoon Jeong, Donghee Kim, Dong Won Kim, Seungho Baek, Hyung-Chul Lee, Yusung Kim, Hyun Joo Ahn
{"title":"Prediction of intraoperative hypotension using deep learning models based on non-invasive monitoring devices.","authors":"Heejoon Jeong, Donghee Kim, Dong Won Kim, Seungho Baek, Hyung-Chul Lee, Yusung Kim, Hyun Joo Ahn","doi":"10.1007/s10877-024-01206-6","DOIUrl":"10.1007/s10877-024-01206-6","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative hypotension is associated with adverse outcomes. Predicting and proactively managing hypotension can reduce its incidence. Previously, hypotension prediction algorithms using artificial intelligence were developed for invasive arterial blood pressure monitors. This study tested whether routine non-invasive monitors could also predict intraoperative hypotension using deep learning algorithms.</p><p><strong>Methods: </strong>An open-source database of non-cardiac surgery patients ( https://vitadb.net/dataset ) was used to develop the deep learning algorithm. The algorithm was validated using external data obtained from a tertiary Korean hospital. Intraoperative hypotension was defined as a systolic blood pressure less than 90 mmHg. The input data included five monitors: non-invasive blood pressure, electrocardiography, photoplethysmography, capnography, and bispectral index. The primary outcome was the performance of the deep learning model as assessed by the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>Data from 4754 and 421 patients were used for algorithm development and external validation, respectively. The fully connected model of Multi-head Attention architecture and the Globally Attentive Locally Recurrent model with Focal Loss function were able to predict intraoperative hypotension 5 min before its occurrence. The AUROC of the algorithm was 0.917 (95% confidence interval [CI], 0.915-0.918) for the original data and 0.833 (95% CI, 0.830-0.836) for the external validation data. Attention map, which quantified the contributions of each monitor, showed that our algorithm utilized data from each monitor with weights ranging from 8 to 22% for determining hypotension.</p><p><strong>Conclusions: </strong>A deep learning model utilizing multi-channel non-invasive monitors could predict intraoperative hypotension with high accuracy. Future prospective studies are needed to determine whether this model can assist clinicians in preventing hypotension in patients undergoing surgery with non-invasive monitoring.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1357-1365"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michele Introna, Morgan Broggi, Paolo Ferroli, Donato Martino, Carmela Pinto, Monica Carpenedo, Marco Gemma
{"title":"Perioperative ROTEM® evaluation in a patient affected by severe VII factor deficiency undergoing microvascular decompression craniotomy for hemifacial spasm.","authors":"Michele Introna, Morgan Broggi, Paolo Ferroli, Donato Martino, Carmela Pinto, Monica Carpenedo, Marco Gemma","doi":"10.1007/s10877-024-01183-w","DOIUrl":"10.1007/s10877-024-01183-w","url":null,"abstract":"<p><p>The potential use of TEG/ROTEM® in evaluating the bleeding risk for rare coagulation disorders needs to be assessed, considering the common mismatch among laboratory tests and the clinical manifestations. As a result, there is currently no published data on the use of viscoelastic tests to assess coagulation in FVII deficient patients undergoing elective neurosurgery. We describe the case of a patient affected by severe FVII deficiency who underwent microvascular decompression (MVD) craniotomy for hemifacial spasm (HFS). The ROTEM® did not show a significant coagulopathy according to the normal ranges, before and after the preoperative administration of the recombinant activated FVII, but a substantial reduction in EXTEM and FIBTEM Clotting Times was noted. The values of coagulation in standard tests, on the contrary, were indicative of a coagulopathy, which was corrected by the administration of replacement therapy. Whether this difference between ROTEM® and standard tests is due to the inadequacy of thromboelastographic normal ranges in this setting, or to the absence of clinically significant coagulopathy, has yet to be clarified. Neurosurgery is a typical high bleeding risk surgery; additional data is required to clarify the potential role for thromboelastographic tests in the perioperative evaluation of the FVII deficient neurosurgical patients.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1431-1435"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Respiratory rate measurement by pressure variation in the high flow nasal cannula-system in healthy volunteers.","authors":"Jeffrey Miechels, Mark V Koning","doi":"10.1007/s10877-024-01185-8","DOIUrl":"10.1007/s10877-024-01185-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study tests if the pressure variation in the HFNC-system may allow for monitoring of respiratory rate and the pressure difference during breathing may be a marker of respiratory effort.</p><p><strong>Methods: </strong>A HFNC system (Fisher & Paykel Optiflow Thrive 950) was modified by adding a GE Healthcare D-Lite spirometry sensor attached to a respiratory module and a pressure transducer. Participants were instructed to breathe regularly, quickly and slowly during 4 different conditions (HFNC flow 30 l/min and 70 l/min and with an open and closed mouth). Respiratory rate was counted based on pressure variation shown on the monitor graphs and compared with the count by observation of the participant. The pressure difference between inspiration and expiration was tested for correlation with the respiratory rate, as a surrogate marker for respiratory effort.</p><p><strong>Results: </strong>Twenty five participants were included in this study. False detection of apnea in pressure-based measurements occurred in 10% and 11% of the measurements with open mouth position at 30 l/min and 70 l/min HFNC-flow, respectively, but not with a closed mouth. The 95% Limits of Agreement were - 1.85;1.91, -13.72;9,88, -2.25;2.47, -30.32;19.93 for the conditions of 30 l/min -closed mouth, 30 l/min - open mouth, 70 l/min - closed mouth and 70 l/min - open mouth, respectively. There was a correlation between pressure difference and respiratory effort, except for the condition of 30 l/min with open mouth.</p><p><strong>Conclusions: </strong>The pressure variation in the HFNC system allows for respiratory rate and effort monitoring, but requires further development to increase precision.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05991843).</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1397-1404"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Publishing guidelines, recommendations and opinions: how the Journal of Clinical Monitoring and Computing is playing the game.","authors":"Silvia Fernandez Mulero, Francisco A Lobo","doi":"10.1007/s10877-024-01238-y","DOIUrl":"10.1007/s10877-024-01238-y","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1225-1226"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The impact of a lung-protective ventilation mode using transpulmonary driving pressure titrated positive end-expiratory pressure on the prognosis of patients with acute respiratory distress syndrome.","authors":"Jian Sun, Jing Gao, Guan-Dong Huang, Xiao-Guang Zhu, Yan-Ping Yang, Wei-Xi Zhong, Lei Geng, Min-Jie Zhou, Qing Xu, Qi-Ming Feng, Gang Zhao","doi":"10.1007/s10877-024-01198-3","DOIUrl":"10.1007/s10877-024-01198-3","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the impact of a lung-protective ventilation strategy utilizing transpulmonary driving pressure titrated positive end-expiratory pressure (PEEP) on the prognosis [mechanical ventilation duration, hospital stay, 28-day mortality rate and incidence of ventilator-associated pneumonia (VAP), survival outcome] of patients with Acute Respiratory Distress Syndrome (ARDS).</p><p><strong>Methods: </strong>A total of 105 ARDS patients were randomly assigned to either the control group (n = 51) or the study group (n = 53). The control group received PEEP titration based on tidal volume [A tidal volume of 6 mL/kg, flow rate of 30-60 L/min, frequency of 16-20 breaths/min, constant flow rate, inspiratory-to-expiratory ratio of 1:1 to 1:1.5, and a plateau pressure ≤ 30-35 cmH<sub>2</sub>O. PEEP was adjusted to maintain oxygen saturation (SaO<sub>2</sub>) at or above 90%, taking into account blood pressure], while the study group received PEEP titration based on transpulmonary driving pressure (Esophageal pressure was measured as a surrogate for pleural pressure using an esophageal pressure measurement catheter connected to the ventilator. Tidal volume and PEEP were adjusted based on the observed end-inspiratory and end-expiratory transpulmonary pressures, aiming to maintain a transpulmonary driving pressure below 15 cmH<sub>2</sub>O during mechanical ventilation. Adjustments were made 2-4 times per day). Statistical analysis and comparison were conducted on lung function indicators [oxygenation index (OI), arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2)] as well as other measures such as heart rate, mean arterial pressure, and central venous pressure in two groups of patients after 48 h of mechanical ventilation. The 28-day mortality rate, duration of mechanical ventilation, length of hospital stay, and ventilator-associated pneumonia (VAP) incidence were compared between the two groups. A 60-day follow-up was performed to record the survival status of the patients.</p><p><strong>Results: </strong>In the control group, the mean age was (55.55 ± 10.51) years, with 33 females and 18 males. The pre-ICU hospital stay was (32.56 ± 9.89) hours. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was (19.08 ± 4.67), and the mean Murray Acute Lung Injury score was (4.31 ± 0.94). In the study group, the mean age was (57.33 ± 12.21) years, with 29 females and 25 males. The pre-ICU hospital stay was (33.42 ± 10.75) hours. The mean APACHE II score was (20.23 ± 5.00), and the mean Murray Acute Lung Injury score was (4.45 ± 0.88). They presented a homogeneous profile (all P > 0.05). Following intervention, significant improvements were observed in PaO<sub>2</sub> and OI compared to pre-intervention values. The study group exhibited significantly higher PaO<sub>2</sub> and OI compared to the control group, with statistically significant differences (all P < 0.05). After inte","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1405-1414"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hisako Nishimoto, Tadayoshi Kurita, Mikihiro Shimizu, Koji Morita, Yoshiki Nakajima
{"title":"Correction: Predicted effect-site concentrations of remimazolam for i-gel insertion: a prospective randomized controlled study.","authors":"Hisako Nishimoto, Tadayoshi Kurita, Mikihiro Shimizu, Koji Morita, Yoshiki Nakajima","doi":"10.1007/s10877-024-01228-0","DOIUrl":"10.1007/s10877-024-01228-0","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1441"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sérgio Brasil, Danilo Cardim, Juliana Caldas, Chiara Robba, Fabio Silvio Taccone, Marcelo de-Lima-Oliveira, Márcia Harumy Yoshikawa, Luiz Marcelo Sá Malbouisson, Wellingson S Paiva
{"title":"Predicting short-term outcomes in brain-injured patients: a comprehensive approach with transcranial Doppler and intracranial compliance assessment.","authors":"Sérgio Brasil, Danilo Cardim, Juliana Caldas, Chiara Robba, Fabio Silvio Taccone, Marcelo de-Lima-Oliveira, Márcia Harumy Yoshikawa, Luiz Marcelo Sá Malbouisson, Wellingson S Paiva","doi":"10.1007/s10877-024-01181-y","DOIUrl":"10.1007/s10877-024-01181-y","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1237-1247"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ole C Keim, Lennart Bolwin, Robert E Feldmann, Manfred Thiel, Justus Benrath
{"title":"Heart rate variability as a predictor of intraoperative autonomic nervous system homeostasis.","authors":"Ole C Keim, Lennart Bolwin, Robert E Feldmann, Manfred Thiel, Justus Benrath","doi":"10.1007/s10877-024-01190-x","DOIUrl":"10.1007/s10877-024-01190-x","url":null,"abstract":"<p><p>The aim of the proof-of-concept study is to investigate the level of concordance between the heart rate variability (HRV), the EEG-based Narcotrend Index as a surrogate marker for the depth of hypnosis, and the minimal alveolar concentration (MAC) of the inhalation anesthetic sevoflurane across the entire course of a surgical procedure. This non-blinded cross-sectional study recorded intraoperative HRV, Narcotrend Index, and MAC in 31 male patients during radical prostatectomy using the Da-Vinci robotic-assisted surgical system at Mannheim University Medical Center. The degree of concordance was calculated using repeated measures correlation with the R package (rmcorr) and presented using the rmcorr coefficient (rrm). The Narcotrend Index correlates significantly across all measures with the time-dependent parameter of HRV, the standard deviation of the means of RR intervals (SDNN) (rrm = 0.2; p < 0.001), the frequency-dependent parameters low frequency (LF) (rrm = 0.09; p = 0.04) and the low frequency/high frequency ratio (LF/HF ratio) (rrm = 0.11; p = 0.002). MAC correlated significantly negatively with the time-dependent parameter of heart rate variability, SDNN (rrm = -0.28; p < 0.001), the frequency-dependent parameter LF (rrm = -0.06; p < 0.001) and the LF/HF ratio (rrm = -0.18; p < 0.001) and the Narcotrend Index (rrm = -0.49; p < 0.001) across all measures. HRV mirrors the trend of the Narcotrend Index used to monitor depth of hypnosis and the inhibitory influence of the anesthetic sevoflurane on the autonomic nervous system. Therefore, HRV can provide essential information about the homeostasis of the autonomic nervous system during general anesthesia. DRKS00024696, March 9th, 2021.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1305-1313"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriela Nagai Ocamoto, Lucas Normando da Silva, Camila da Silva Rocha Tomaz, Matheus Toshio Hisatugu, Gustavo Frigieri, Danilo Cardim, Roberta Lins Gonçalves, Thiago Luiz Russo, Robson Luis Oliveira de Amorim
{"title":"Characterization of intracranial compliance in healthy subjects using a noninvasive method - results from a multicenter prospective observational study.","authors":"Gabriela Nagai Ocamoto, Lucas Normando da Silva, Camila da Silva Rocha Tomaz, Matheus Toshio Hisatugu, Gustavo Frigieri, Danilo Cardim, Roberta Lins Gonçalves, Thiago Luiz Russo, Robson Luis Oliveira de Amorim","doi":"10.1007/s10877-024-01191-w","DOIUrl":"10.1007/s10877-024-01191-w","url":null,"abstract":"<p><strong>Purpose: </strong>An FDA-approved non-invasive intracranial pressure (ICP) monitoring system enables the assessment of ICP waveforms by revealing and analyzing their morphological variations and parameters associated with intracranial compliance, such as the P2/P1 ratio and time-to-peak (TTP). The aim of this study is to characterize intracranial compliance in healthy volunteers across different age groups.</p><p><strong>Methods: </strong>Healthy participants, both sexes, aged from 9 to 74 years old were monitored for 5 min in the supine position at 0º. Age was stratified into 4 groups: children (≤ 7 years); young adults (18 ≤ age ≤ 44 years); middle-aged adults (45 ≤ age ≤ 64 years); older adults (≥ 65 years). The data obtained was the non-invasive ICP waveform, P2/P1 ratio and TTP.</p><p><strong>Results: </strong>From December 2020 to February 2023, 188 volunteers were assessed, of whom 104 were male, with a median (interquartile range) age of 41 (29-51), and a median (interquartile range) body mass index of 25.09 (22.57-28.04). Men exhibited lower values compared to women for both the P2/P1 ratio and TTP (p < 0.001). There was a relative rise in both P2/P1 and TTP as age increased (p < 0.001).</p><p><strong>Conclusions: </strong>The study revealed that the P2/P1 ratio and TTP are influenced by age and sex in healthy individuals, with men displaying lower values than women, and both ratios increasing with age. These findings suggest potential avenues for further research with larger and more diverse samples to establish reference values for comparison in various health conditions.</p><p><strong>Trial registration: </strong>Brazilian Registry of Clinical Trials (RBR-9nv2h42), retrospectively registered 05/24/2022. UTN: U1111-1266-8006.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1249-1261"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}