Neurocritical Care最新文献

{"title":"SAHRANG: Subarachnoid Hemorrhage Recovery and Galantamine: A Pilot Multicenter Randomized Placebo-Controlled Trial.","authors":"Bosco Seong Kyu Yang, Jude P J Savarraj, Elena Moreno, Kevin E Immanuel, Georgene Hergenroeder, Glenda Torres, Jung Hwan Kim, Sophie Samuel, Claudia Pedroza, James C Grotta, Andrew Barreto, H Alex Choi","doi":"10.1007/s12028-025-02349-3","DOIUrl":"10.1007/s12028-025-02349-3","url":null,"abstract":"<p><strong>Background: </strong>Subarachnoid hemorrhage (SAH) causes life-long neurologic dysfunction. Peripheral inflammatory processes as a reaction to brain injury have been shown to worsen outcomes after SAH. Galantamine has been shown to reduce proinflammatory microglial activities and improve synaptic connections. We hypothesize that galantamine treatment after SAH mitigates inflammation-mediated neuronal injury and improve outcomes. We conducted a pilot clinical trial to examine the tolerability and safety of galantamine in patients with SAH.</p><p><strong>Methods: </strong>This prospective, multicenter, double-masked, randomized, placebo-controlled study contiguously screened and enrolled adult patients presenting with aneurysmal SAH with a Fisher grade of 3 within 72 h of symptom onset. A total of 60 patients were enrolled with a 1:1 ratio to two treatment arms. The first 30 patients were randomly assigned to receive galantamine at 8 mg every 12 h or a placebo, and the other 30 patients to were randomly assigned to receive either galantamine at 12 mg every 12 h or a placebo. All medications were started within 36 h after securing the aneurysm and continued for 90 days. Primary outcomes-tolerability as assessed by the number of patients who stop study medication due to adverse events associated with the study drug and mortality due to the study drug-were assessed at 90 days.</p><p><strong>Results: </strong>There were no differences in tolerability and safety between the two groups. Bradycardia was the most common adverse event (37%), followed by clinical seizure (3%) and skin rash (3%). One study participant in the galantamine group discontinued medication due to a skin rash, and another study participant from the placebo group discontinued due to nausea (p = 0.92). Mortality did not differ between the two groups. At 90 days, one study participant from the galantamine group and four study participants from the placebo group died (p = 0.34).</p><p><strong>Conclusions: </strong>Galantamine was as tolerable and safe as a placebo based on discontinuation rates and mortality in patients with SAH when administered to patients with SAH during the early and subacute stages of the disease.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144961657","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":"The Etiology Analysis of Myasthenia Gravis with In-Hospital Mortality in the Neurocritical Care Unit.","authors":"Hongxi Chen, Yuan Wang, Nana Zhang, Jie Song, Xue Lin, Chong Yan, Xiao Huan, Ziyan Shi, Xiaofei Wang, Ying Zhang, Qin Du, Lingyao Kong, Dongren Sun, Rui Wang, Ziya Wang, Yangyang Zhang, Jianying Xi, Chongbo Zhao, Hongyu Zhou, Sushan Luo","doi":"10.1007/s12028-025-02352-8","DOIUrl":"https://doi.org/10.1007/s12028-025-02352-8","url":null,"abstract":"<p><strong>Background: </strong>Our objective was to investigate the characteristics and causes of death in deceased patients with myasthenia gravis (MG).</p><p><strong>Methods: </strong>This study conducted a retrospective analysis of data from patients with MG in the neurocritical unit at two large general hospitals in China spanning 10 years, from January 2014 to December 2023. Detailed demographic and clinical information were collected for deceased patients. Experienced physicians determined both the underlying and direct causes of death.</p><p><strong>Results: </strong>Among 3723 patients, the overall hospitalized mortality was 79 (2.12%). Thymoma was present in 52 (65.82%) of these patients. Compared with the nonthymomatous MG (NTMG) group (n = 27), patients with thymomatous MG (TMG) (n = 52) were significantly younger at death (53.71 ± 14.01 years vs. 65.37 ± 14.61 years, p = 0.001). Septic shock was the most common underlying cause of death, affecting 32 (40.51%) patients, followed by myasthenic crisis in 18 (22.78%) patients. This trend was observed in both the TMG and NTMG groups. In the TMG group, fulminant myocarditis was the third leading underlying cause of death in 9 (17.31%) patients, whereas no cases of fulminant myocarditis were reported in the NTMG group. Among all deceased patients (n = 79), pneumonia was the most common infection, affecting 55 (69.62%) patients, followed by urinary tract infections in 14 (17.72%) patients, bloodstream infections in 13 (16.46%) patients, and intracranial infections in 7 (8.86%) patients.</p><p><strong>Conclusions: </strong>The study suggests that thymoma may increase the risk of death, with septic shock and myasthenic crisis being the most frequent underlying causes in patients with MG.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962340","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":"Clinical Applications of Point-of-Care and Diagnostic Transcranial Doppler in the Pediatric Acute Care Setting: A Scoping Review.","authors":"Virginie Plante, Nicole O'Brien, Simon MacDonald, Laurence Tabone, Camille Jutras, Eric Dornoff, Catherine Boulet, Kerri LaRovere","doi":"10.1007/s12028-025-02341-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02341-x","url":null,"abstract":"<p><p>Transcranial Doppler (TCD) is increasingly used in pediatric acute care with emerging point-of-care ultrasound (POCUS) applications. However, no standardized definition distinguishes POCUS TCD from diagnostic/consultative TCD. This scoping review aims to (1) examine how the terminology \"POCUS TCD\" is used in pediatric literature, (2) describe physiologic indications driving TCD use in pediatric acute care settings, and (3) compare contexts of performance and operational characteristics across these indications. A comprehensive scoping review was conducted following published guidelines. Databases were searched from inception to June 2024 for studies addressing TCD use in children (≤ 18 years) in emergency departments, inpatient services, or intensive care units. Full-text eligibility and data extraction were performed in duplicate by independent reviewers. Of 4,066 screened studies, 660 full texts were assessed, and 307 studies met eligibility criteria (258 original studies and 49 reviews, guidelines, or surveys). The term \"POCUS TCD\" was mentioned in only 3% of original studies and 26% of included reviews and guidelines, which were mostly published after 2018. Eleven physiologic indications for TCD use were identified, and specific subtypes of context of use emerged. TCD operational characteristics varied widely and were often incompletely reported. However, notable differences were observed across physiologic indications, particularly in TCD extent, operator type, and use of point-of-care machines. The terminology \"POCUS TCD\" is infrequently used in current pediatric research, and most studies do not specify the type of TCD performed or intended. Significant differences in the context of performance and operational characteristics across physiologic indications suggest the coexistence of distinct forms of TCD in current clinical practice despite the lack of explicit distinction between POCUS and diagnostic/consultative TCD. Standardizing terminology and improving reporting of operational contexts in future research will be essential to support safe and effective clinical integration of TCD in pediatric critical care.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962532","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":"Transfusion in Surgical SAH: Between Guidelines, New Evidence, and Physiology.","authors":"Cyril Pernod, Hilaire de Malleray, Philippe Goutorbe","doi":"10.1007/s12028-025-02346-6","DOIUrl":"https://doi.org/10.1007/s12028-025-02346-6","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962322","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":"Impact of Nimodipine-Induced Blood Pressure Reductions on Cerebral Autoregulation and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage.","authors":"Kaitlyn A Stoehr, David Bartolome, Sithmi Jayasundara, Pwint Thinzar, David Vargas, Jennifer Kim, Jessica Magid-Bernstein, Lena M O'Keefe, Adam de Havenon, Ryan Hebert, Charles Matouk, Kevin N Sheth, Emily J Gilmore, Santiago Ortega-Gutierrez, Nils H Petersen","doi":"10.1007/s12028-025-02338-6","DOIUrl":"https://doi.org/10.1007/s12028-025-02338-6","url":null,"abstract":"<p><strong>Background: </strong>Impairment of cerebral autoregulation following aneurysmal subarachnoid hemorrhage (aSAH) increases susceptibility to secondary injury from blood pressure (BP) fluctuations. Although nimodipine is recommended to improve neurological outcomes, it is frequently associated with BP reduction. In this observational cohort study, we examined the effect of nimodipine-induced BP reductions that exceed autoregulatory capacity on functional outcome following aSAH.</p><p><strong>Methods: </strong>Autoregulatory function was measured continuously following aneurysm securement by correlating near-infrared spectroscopy-derived regional oxygen saturation with mean arterial pressure (MAP). The resulting autoregulatory index was used to derive the lower and upper limits of autoregulation (LLA and ULA). Physiologic parameters were compared between the hour before and the hour after nimodipine administration using linear mixed-effects models. Ordinal regression was used to assess the relationship between time with MAP below the LLA and functional outcome, as measured by the modified Rankin scale at 90 days post discharge.</p><p><strong>Results: </strong>Analysis included 682 nimodipine administrations among 31 patients with moderate to severe aSAH (mean age 57 ± 14 years, 71% female, median Hunt & Hess score 4 [interquartile range (IQR) 2-4], modified Fisher grade 4 [IQR 3-4], monitoring time 5.5 ± 4.7 days). Following nimodipine, MAP decreased from a mean ± SEM of 105.9 ± 0.7 to 100.1 ± 0.7 mm Hg (p < 0.001), resulting in increased time below the LLA from a mean ± SEM of 5.3 ± 0.5 to 13.9 ± 0.7 min (p < 0.001). Mean time below the LLA was significantly associated with worse functional outcome at 90 days (odds ratio for 10-min increase 3.6, 95% confidence interval 1.6-8.0, p = 0.0015). This association remained significant after adjusting separately for age, Hunt & Hess score, modified Fisher grade, delayed cerebral ischemia, and the magnitude of BP response to nimodipine.</p><p><strong>Conclusions: </strong>Nimodipine-induced BP reductions below personalized limits of autoregulation may be associated with worse functional outcome after aSAH. Further prospective studies are warranted to explore how autoregulatory sensitivity to nimodipine can be used to identify vulnerable patients and maximize benefits from current clinical interventions.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962564","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":"Safety of Peripherally Administered 23.4% Sodium Chloride.","authors":"Christian R Silva, Jessica Nagy, Andrew R Zullo, Rebecca A Greene","doi":"10.1007/s12028-025-02342-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02342-w","url":null,"abstract":"<p><strong>Background: </strong>For patients with increased intracranial pressure, prompt initiation of hyperosmolar therapy with 23.4% sodium chloride may minimize permanent neurological damage and prevent cerebral herniation. Placement of a central venous catheter can delay time to osmotherapy and may negatively impact patient outcomes. The objective of this study was to examine the safety of 23.4% sodium chloride administered through a peripheral intravenous (IV) catheter.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study conducted at a large academic health system. Patients were admitted to one 719-bed academic medical center and a level I trauma center or one 247-bed academic community hospital. Study participants were 18 years or older, admitted between March 29, 2015, and October 21, 2023, and received 23.4% sodium chloride through a peripheral IV. Patients who died within 24 h of 23.4% sodium chloride administration or were discharged less than 24 h after administration were excluded. All study participants received at least one 30 mL bolus of 23.4% sodium chloride administered through a peripheral IV catheter.</p><p><strong>Results: </strong>The primary outcome, defined as extravasation of peripherally administered 23.4% sodium chloride, was assessed using the Naranjo Adverse Drug Reaction Probability Scale and occurred in 56 of 863 administrations (6.4%). Secondary outcomes included incidence of tissue necrosis, interventions used to treat extravasations, and attributable risk factors for extravasation. There were no cases of tissue necrosis, no surgical interventions performed, and one case of medical intervention using hyaluronidase. Patients with a history of diabetes had a 2.39 times higher risk of experiencing a 23.4% sodium chloride extravasation event (95% CI 1.41-4.05, p = 0.001).</p><p><strong>Conclusions: </strong>Peripheral administration of 23.4% sodium chloride was associated with a low rate of extravasation and no significant injury in patients who did experience a possible or probable extravasation event. Diabetes mellitus was a possible risk factor for extravasation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962540","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":"Analgesia, Sedation, and Neuromuscular Blockade in Pediatric Severe Traumatic Brain Injury: Secondary Analysis of the \"Approaches and Decisions in Acute Pediatric TBI Trial\" (ADAPT).","authors":"Jennifer Clancy Laws, Jaskaran Rakkar, Sandra D W Buttram, Michael Seth Wolf","doi":"10.1007/s12028-025-02336-8","DOIUrl":"10.1007/s12028-025-02336-8","url":null,"abstract":"<p><strong>Background: </strong>Sedative, analgesia, and neuromuscular blocking (NMB) medications may be necessary in the acute management of pediatric severe traumatic brain injury (sTBI), yet limited data exist to guide their use. We aimed to describe the use of continuous infusions of these medications in children with sTBI, to determine temporal trends during the first week of management, and to evaluate associations with in-hospital mortality.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial (NCT04077411, 2014-2017), a prospective multicenter observational study of patients < 18 years old with sTBI (Glasgow Coma Scale ≤ 8) who underwent intracranial pressure monitoring. Continuous analgesic, sedative, and NMB medication infusions administered in the first 7 days after sTBI were analyzed.</p><p><strong>Results: </strong>Data from 929 patients were analyzed with a median Glasgow Coma Scale of 6 (interquartile range 3-7), 14% hospital mortality. In the 7 days after intracranial pressure monitor placement, 866 (93%) patients received an opioid infusion, with 659 (71%) patients having received fentanyl. A total of 679 (73%) patients received benzodiazepine: 671 (72%) patients received midazolam. A total of 362 (39%) patients received NMB, with the most common being vecuronium, administered to 141 (15%) patients. Propofol was administered to 264 (28%) patients, alpha-2 agonist to 263 (28%) patients, and ketamine to 4 (0.43%) patients. The median number of infusions per patient was 2 (interquartile range 1-2), with the highest number on intensive care unit day 2. Morphine and dexmedetomidine infusions were used more often in survivors than nonsurvivors (33 vs. 16%, and 30 vs. 9%, respectively, p < 0.001).</p><p><strong>Conclusions: </strong>Fentanyl and midazolam were the most common analgesic and sedative continuous infusions during acute pediatric sTBI management. Propofol and dexmedetomidine were used less frequently. Opioid (specifically morphine) and dexmedetomidine infusions were associated with survival. Larger studies are needed to determine the safest and most effective analgesia, sedation, and NMB medication strategy for children with sTBI.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859388","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":"Effect of Red Blood Cell Transfusion on Cerebral Ischemia in Critically Ill Patients with Acute Brain Injury.","authors":"Timothée Ayasse, Emma Berthe, Ellington Barnes, Samuel Gaugain, Benjamin G Chousterman, Romain Barthélémy","doi":"10.1007/s12028-025-02333-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02333-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847958","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":"Evolution of Perihematomal Edema Mean Hounsfield Unit and Its Association with Clinical Outcome in Intracerebral Hemorrhage: A Post Hoc Analysis of the i-DEF Trial.","authors":"Alexandros A Polymeris, Vasileios-Arsenios Lioutas, Diego Incontri, Salil Soman, Magdy H Selim","doi":"10.1007/s12028-025-02337-7","DOIUrl":"https://doi.org/10.1007/s12028-025-02337-7","url":null,"abstract":"<p><strong>Background: </strong>Lower mean Hounsfield unit (mHU) values, indicating greater computed tomography (CT) hypodensity of perihematomal edema (PHE), have been proposed as a novel quantitative imaging marker in intracerebral hemorrhage (ICH). We explored its evolution and prognostic importance in a post hoc analysis of the Intracerebral Hemorrhage-Deferoxamine trial (NCT02175225).</p><p><strong>Methods: </strong>We included participants with primary supratentorial ICH who had available CT scans at baseline and follow-up after 72-96 h and 90-days and/or 180-days outcome data. The primary exposure variable was the mHU of PHE measured on the follow-up CT scan. We investigated (1) its change from baseline and (2) its association with unfavorable outcome (modified Rankin Scale score 3-6) in adjusted mixed-effects models, accounting for between-center and between-participant variability.</p><p><strong>Results: </strong>Among 273 of 293 Intracerebral Hemorrhage-Deferoxamine trial participants eligible for analysis (median age 61 years, 39% female), the median (interquartile range) mHU of PHE was 30.3 (28.3-32.7) at baseline and 26.9 (24.6-29.2) at follow-up. Τhe mHU of PHE decreased from baseline to follow-up scan by an average of 3.6 (95% confidence interval [CI] 3.2-4.0, p < 0.001). There was no association between the mHU of follow-up PHE with unfavorable outcome at 90 days (n = 273; odds ratio 1.05, 95% CI 0.95-1.17, p = 0.32), or at 180 days (n = 261; odds ratio 1.01, 95% CI 0.92-1.11, p = 0.81).</p><p><strong>Conclusions: </strong>Perihematomal edema after ICH tends to grow more hypodense on CT by day 3-4 compared with baseline. The degree of PHE hypodensity was not associated with long-term clinical outcomes in the setting of a multicenter randomized trial, challenging its utility as a radiological marker in ICH research.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov: NCT02175225.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822123","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":"Noninvasive Intracranial Pressure Prediction Using a Multimodal Ultrasound-Based Hemispheric Modeling Strategy: A Prospective Dual-Center Study.","authors":"Jun Qiu, Tong-Juan Zou, Dong-Mei Wang, Hai-Rong Luo, Hai-Tao Yu, Ling Lei, Wan-Hong Yin","doi":"10.1007/s12028-025-02339-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02339-5","url":null,"abstract":"<p><strong>Background: </strong>Accurate intracranial pressure (ICP) surveillance is a cornerstone of neurocritical care management, yet invasive monitoring still depends on neurosurgical expertise, specialized hardware, and continuous bedside resources-factors that restrict universal use even though insertion-related complications are relatively uncommon. Contemporary noninvasive ultrasound methods have limited predictive accuracy and seldom incorporate affected side information. We therefore preliminarily validated a multimodal, ultrasound-based hemispheric modeling approach that blends hemodynamic and structural indexes while emphasizing affected side specificity to enhance ICP prediction.</p><p><strong>Methods: </strong>In this prospective, dual-center study, 41 neurosurgical patients provided 216 paired ultrasound and invasive ICP measurements. Affected side and contralateral ultrasound parameters including pulsatility index, resistance index, optic nerve sheath diameter (ONSD), optic disk height, and ONSD-to-eyeball diameter ratio were analyzed. Linear mixed-effects models (LMMs) predicted continuous ICP, whereas generalized LMMs classified elevated ICP (≥ 20 mm Hg).</p><p><strong>Results: </strong>Affected side parameters showed consistently stronger ICP correlations than unaffected side parameters. An affected side five-parameter LMM (pulsatility index, resistance index, ONSD, ONSD-to-eyeball diameter ratio, and optic disk height) provided superior continuous ICP prediction (coefficient of determination [R²] = 0.618, root mean square error = 0.424), significantly outperforming contralateral models (R² = 0.338, root mean square error = 0.558). For binary classification, affected side ONSD demonstrated excellent accuracy (area under the receiver operating characteristic curve = 0.927, sensitivity = 91.4%, specificity = 79.5%), whereas the optimal affected side seven-parameter generalized LMM reached an area under the receiver operating characteristic curve of 0.829 (sensitivity = 80.8%, specificity = 75.8%).</p><p><strong>Conclusions: </strong>This study demonstrated the feasibility and potential advantages of a novel hemispheric (side-specific) modeling strategy for noninvasive ICP assessment. The multiparameter model constructed using affected side ultrasound parameters exhibited promising predictive accuracy, providing a potentially valuable and innovative noninvasive approach for ICP monitoring in neurocritical care patients that may serve as an adjunct when invasive monitoring is unavailable, although further validation is warranted.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822125","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}