Magdalena Kasprowicz, Agnieszka Kazimierska, Marta Hendler, Danilo Cardim, Zofia Czosnyka, Marek Czosnyka, Wellingson Paiva, Sergio Brasil
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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).</p><p><strong>Results: </strong>Bland-Altman analysis demonstrated good agreement between PSI<sub>ICP</sub> and PSI<sub>B4C</sub>, with approximately 6% outliers. PSI was significantly higher in patients who underwent craniectomy compared with those with intact skulls (PSI<sub>ICP</sub>: 3.5 (0.8) vs. 2.0 (1.2) arbitrary units, p < 0.002; PSI<sub>B4C</sub>: 3.0 (0.4) vs. 2.0 (0.6) arbitrary units, p < 0.005) or those with craniotomies or large fractures (PSI<sub>ICP</sub>: 3.5 (0.8) vs. 2.0 (2.1) arbitrary units, p < 0.05; PSI<sub>B4C</sub>: 3.0 (0.4) vs. 2.0 (2.2) arbitrary units, p < 0.05). IJV compression did not affect PSI. Both PSI<sub>ICP</sub> (r<sub>s</sub> = 0.35, p < 0.02) and PSI<sub>B4C</sub> (r<sub>s</sub> = 0.37, p = 0.01) correlated with age.</p><p><strong>Conclusions: </strong>This study supports the B4C signal's capability to noninvasively reflect ICP waveform morphology via PSI, offering a promising monitoring alternative. 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This study assessed the agreement between PSI derived from invasive ICP monitoring (PSI<sub>ICP</sub>) and noninvasive brain4care (B4C) sensor signal (PSI<sub>B4C</sub>) and investigated the influence of cranial integrity, age, and internal jugular vein (IJV) compression on PSI values.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>Bland-Altman analysis demonstrated good agreement between PSI<sub>ICP</sub> and PSI<sub>B4C</sub>, with approximately 6% outliers. 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引用次数: 0
摘要
背景：脉冲形状指数（PSI）是一种新的人工智能支持的参数，通过颅内压（ICP）脉冲波形分类来评估颅脊髓系统的压力-体积代偿储备。本研究评估了有创颅内压监测（PSIICP）和无创颅内压（B4C）传感器信号（PSIB4C）之间的一致性，并探讨了颅骨完整性、年龄和颈内静脉（IJV）压迫对PSI值的影响。方法：对47例成人患者（年龄43（30）岁）在IJV按压前和按压过程中同时进行ICP和B4C监测。患者按颅骨完整性分组：完整颅骨（n = 17）、大颅骨骨折或开颅手术（n = 17）和开颅手术（n = 13）。通过神经网络将脉冲波形自动分为4类（1 =正常到4 =病理），PSI作为类数的加权平均值。数值以中位数（四分位数范围）表示。结果：Bland-Altman分析表明PSIICP和PSIB4C之间具有良好的一致性，大约有6%的异常值。与颅骨完整的患者相比，行颅骨切除术的患者PSI明显高于年龄(PSIICP: 3.5 (0.8) vs. 2.0（1.2）任意单位，pb4c: 3.0 (0.4) vs. 2.0（0.6）任意单位，picp: 3.5 (0.8) vs. 2.0（2.1）任意单位，pb4c: 3.0 （0.4) vs. 2.0（2.2）任意单位），p ICP (rs = 0.35, p B4C （rs = 0.37, p = 0.01）相关。结论：本研究支持B4C信号通过PSI无创反映ICP波形形态的能力，提供了一种有前途的监测替代方案。PSI似乎受年龄和开颅手术的影响，但不受IJV压迫引起的轻微、突然的ICP改变的影响。
Invasive and Noninvasive Intracranial Pressure Pulse Waveform in Neurocritical Care Patients with Different Cranium Integrity.
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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