Improved Outcome Prediction in Neurocritical Care Using Multimodal Neuromonitoring
Sérgio Brasil1, Danilo Cardim2, Fabio Taccone3
1University of São Paulo, 2University of Cambridge, 3Universitè Libre de Bruxelles
Objective:
To evaluate the potential role of noninvasive neuromonitoring, using transcranial Doppler (TCD) and the recently developed cranial micro-deformation sensor (B4C), on the outcome prediction of acute brain injury (ABI) patients.
Background:
ABI leads to abnormalities in cerebral hemodynamics (CH) and/or intracranial compliance (ICC), all of which significantly impact the outcomes of these patients. TCD and 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.
Design/Methods:
ABI patients undergoing intracranial pressure (ICP) monitoring were assessed within the first 5 days of hospital admission using TCD and B4C. Comprehensive clinical data were collected alongside parameters obtained from TCD (including blood velocities, pulsatility index, estimated ICP and estimated cerebral perfusion pressure [eCPP]) and B4C (measured as the P2/P1 ratio). These parameters were evaluated alone as well as in combinations among them. The short-term outcomes (STO) of interest were the therapy intensity levels (til) for ICP management recommended by the SIBICC, as TIL 0 (STO 1), TIL 1-3 (STO 2) and death (STO 3), at the seventh day after last data collection.
Results:
Results: A total of 98 patients were included, with 67% having experienced traumatic brain injury. 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 areas under the curve (AUC) were 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.
Conclusions:
Conclusion: The combined noninvasive neuromonitoring approach using TCD and B4C demonstrated improved performance in predicting outcomes during the early phase after ABI, supporting the role of multimodal neuromonitoring as ancillary information in the ICU.