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Neurocritical Care
Published in: Neurocritical Care 3/2019

01-06-2019 | Original Article

Evaluation of a New Catheter for Simultaneous Intracranial Pressure Monitoring and Cerebral Spinal Fluid Drainage: A Pilot Study

Authors: Xiuyun Liu, Lara L. Zimmermann, Nhi Ho, Paul Vespa, Xiaoling Liao, Xiao Hu

Published in: Neurocritical Care | Issue 3/2019

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Abstract

Objectives

Intracranial pressure (ICP) monitoring is a common practice when treating intracranial pathology with risk of elevated ICP. External ventricular drain (EVD) insertion is a standard approach for both monitoring ICP and draining cerebrospinal fluid (CSF). However, the conventional EVD cannot serve these two purposes simultaneously because it cannot accurately measure ICP and its pulsatile waveform while the EVD is open to CSF drainage. A new Integra® Camino® FLEX Ventricular Catheter (Integra Lifesciences, County Offaly, Ireland) with a double-lumen construction has been recently introduced into the market, and it can monitor ICP waveforms even during CSF drainage. The aim of this study was to evaluate and validate this new FLEX catheter for ICP monitoring in a neurological intensive care unit.

Methods

Six patients with 34 EVD open/close episodes were retrospectively analyzed. Continuous ICP was detected in two ways: through the FLEX sensor at the tip (ICPf) and through a fluid-coupled manometer within the FLEX catheter, functioning as a conventional EVD (ICPe). The morphologies of ICPf and ICPe pulses were extracted using Morphological Clustering and Analysis of ICP algorithm, an algorithm that has been validated in previous publications. The mean ICP and waveform shapes of ICP pulses detected through the two systems were compared. Bland–Altman plots were used to assess the agreement of the two systems.

Results

A significant linear relationship existed between mean ICPf and mean ICPe, which can be described as: mICPf = 0.81 × mICPe + 1.67 (r = 0.79). The Bland–Altman plot revealed that no significant difference existed between the two ICPs (average of [ICPe–ICPf] was − 1.69 mmHg, 95% limits of agreement: − 7.94 to 4.56 mmHg). The amplitudes of the landmarks of ICP pulse waveforms from the two systems showed strong, linear relationship (r ranging from 0.89 to 0.94).

Conclusions

This study compared a new FLEX ventricular catheter with conventional fluid-coupled manometer for ICP waveform monitoring. Strong concordance in ICP value and waveform morphology between the two systems indicates that this catheter can be used for reliability for both clinical and research applications.
Literature
1.
Kawoos U, McCarron RM, Auker CR, Chavko M. Advances in intracranial pressure monitoring and its significance in managing traumatic brain injury. Int J Mol Sci. 2015;16:28979–97.CrossRefPubMedPubMedCentral
2.
Donnelly J, Budohoski KP, Smielewski P, Czosnyka M. Regulation of the cerebral circulation: bedside assessment and clinical implications. Crit Care. 2016;20:129.CrossRefPubMedPubMedCentral
3.
Hu X, Glenn T, Scalzo F, Bergsneider M, Sarkiss C, Martin N, et al. Intracranial pressure pulse morphological features improved detection of decreased cerebral blood flow. Physiol Meas. 2010;31:679–95.CrossRefPubMedPubMedCentral
4.
Kim MO, Adji A, O’Rourke MF, Avolio AP, Smielewski P, Pickard JD, et al. Principles of cerebral hemodynamics when intracranial pressure is raised: lessons from the peripheral circulation. J Hypertens. 2015;33:1233–41.CrossRefPubMedPubMedCentral
5.
Asgari S, Gonzalez N, Subudhi AW, Hamilton R, Vespa P, Bergsneider M, et al. Continuous detection of cerebral vasodilatation and vasoconstriction using intracranial pulse morphological template matching. PLoS One. 2012;7:e50795.CrossRefPubMedPubMedCentral
6.
7.
Wainwright MS, Lewandowski R. Bioinformatics analysis of mortality associated with elevated intracranial pressure in children. Intracranial Press Brain Monit. 2012;14:67–73.CrossRef
8.
Zoerle T, Lombardo A, Colombo A, Longhi L, Zanier ER, Rampini P, et al. Intracranial pressure after subarachnoid hemorrhage. Crit Care Med. 2014;43:168–76.CrossRef
9.
Shen L, Wang Z, Su Z, Qiu S, Xu J, Zhou Y, et al. Effects of intracranial pressure monitoring on mortality in patients with severe traumatic brain injury: a meta-analysis. PLoS One. 2016;11:e0168901.CrossRefPubMedPubMedCentral
10.
Rangel-Castillo L, Robertson CS. Management of intracranial hypertension. Crit Care Clin. 2006;22(4):713–32.CrossRefPubMed
11.
Liu X, Maurits N, Aries M, Czosnyka M, Ercole A, Donnelly J, et al. Monitoring of optimal cerebral perfusion pressure in traumatic brain injured patients using a multi-window weighting algorithm. J Neurotrauma. 2017;34:3081–8.CrossRefPubMed
12.
Chari A, Dasgupta D, Smedley A, Craven C, Dyson E, Matloob S, et al. Intraparenchymal intracranial pressure monitoring for hydrocephalus and cerebrospinal fluid disorders. Acta Neurochir (Wien). 2017;159:1967–78.CrossRef
13.
Robinson JD. Management of refractory intracranial pressure. Crit Care Nurs Clin North Am. 2016;28:67–75.CrossRefPubMed
14.
Muralidharan R. External ventricular drains: management and complications. Surg Neurol Int. 2015;6:271.CrossRef
15.
Kirmani A, Sarmast A, Bhat A. Role of external ventricular drainage in the management of intraventricular hemorrhage; its complications and management. Surg Neurol Int. 2015;6:188.CrossRefPubMedPubMedCentral
16.
Staykov D, Kuramatsu JB, Bardutzky J, Volbers B, Gerner ST, Kloska SP, et al. Efficacy and safety of combined intraventricular fibrinolysis with lumbar drainage for prevention of permanent shunt dependency after intracerebral hemorrhage with severe ventricular involvement: a randomized trial and individual patient data meta-analysis. Ann Neurol. 2017;81:93–103.CrossRefPubMed
17.
Griesdale DEG, McEwen J, Kurth T, Chittock DR. External ventricular drains and mortality in patients with severe traumatic brain injury. Can J Neurol Sci. 2010;37:43–8.CrossRefPubMed
18.
Lovasik BP, McCracken DJ, McCracken CE, McDougal ME, Frerich JM, Samuels OB, et al. The effect of external ventricular drain use in intracerebral hemorrhage. World Neurosurg. 2016;94:309–18.CrossRefPubMed
19.
de Andrade AF, Paiva WS, Neville IS, Noleto GS, Alves Junior A, Sandon LHD, et al. Monoblock external ventricular drainage system in the treatment of patients with acute hydrocephalus: a pilot study. Med Sci Monit. 2014;20:227.CrossRefPubMedPubMedCentral
20.
Slazinski T, Anderson TA, Cattell E, Eigsti JE, Heimsoth S, Holleman J. Care of the patient undergoing intracranial pressure monitoring/external ventricular drainage or lumbar drainage. Am Assoc Neurosci Nurs. 2011;43:1–38.CrossRef
21.
Berlin T, Murray-Krezan C, Yonas H. Comparison of parenchymal and ventricular intracranial pressure readings utilizing a novel multi-parameter intracranial access system. Springerplus. 2015;4:1–8.CrossRef
22.
23.
Asgari S, Bergsneider M, Hamilton R, Vespa P, Hu X. Consistent changes in intracranial pressure waveform morphology induced by acute hypercapnic cerebral vasodilatation. Neurocrit Care. 2011;15:55–62.CrossRefPubMedPubMedCentral
24.
Hu X, Xu P, Scalzo F, Vespa P, Bergsneider M. Morphological clustering and analysis of continuous intracranial pressure. IEEE Trans Biomed Eng. 2009;56:696–705.CrossRefPubMed
25.
Hu X, Xu P, Lee DJ, Vespa P, Baldwin K, Bergsneider M. An algorithm for extracting intracranial pressure latency relative to electrocardiogram R wave. Physiol Meas. 2008;29:459–71.CrossRefPubMedPubMedCentral
26.
Hu X, Xu P, Asgari S, Vespa P, Bergsneider M. Forecasting ICP elevation based on prescient changes of intracranial pressure waveform morphology. IEEE Trans Biomed Eng. 2010;57:1070–8.CrossRefPubMedPubMedCentral
27.
Trauner DA, Brown F, Ganz E, Huttenlocher PR. Treatment of elevated intracranial pressure in reye syndrome. Ann Neurol. 1978;4:275–8.CrossRefPubMed
28.
29.
Zhong J, Dujovny M, Park HK, Perez E, Perlin AR, Diaz FG. Advances in ICP monitoring techniques. Neurol Res. 2003;25:339–50.CrossRefPubMed
30.
Mahdavi ZK, Olson DM, Figueroa SA. Association patterns of simultaneous intraventricular and intraparenchymal intracranial pressure measurements. Neurosurgery. 2016;79:561–6.CrossRefPubMed
31.
Brean A, Eide PK, Stubhaug A. Comparison of intracranial pressure measured simultaneously within the brain parenchyma and cerebral ventricles. J Clin Monit Comput. 2006;20:411–4.CrossRefPubMed
32.
Chambers IR, Siddique MS, Banister K, Mendelow AD. Clinical comparison of the Spiegelberg parenchymal transducer and ventricular fluid pressure. J Neurol Neurosurg Psychiatry. 2001;71:383–5.CrossRefPubMedPubMedCentral
33.
American National Standards Institute. Intracranial pressure monitoring devices. American National Standards Institute: Arlington; 1993. p. 1993.
34.
Littlejohns L, Bader M. AACN-AACN protocols for practice: monitoring technologies in critically Ill neuroscience patients. Sudbury: Jones and Bartlett; 2008.
35.
Kirkness CJ, Mitchell PH, Burr RL, March KS, Newell DW. Intracranial pressure waveform analysis: clinical and research implications. J Neurosci Nurs. 2000;32:271–7.CrossRefPubMed
36.
Smith M. Monitoring intracranial pressure in traumatic brain injury. Anesth Analg. 2008;106:240–8.CrossRefPubMed
37.
38.
Asgari S, Vespa P, Bergsneider M, Hu X. Lack of consistent intracranial pressure pulse morphological changes during episodes of microdialysis lactate/pyruvate ratio increase. Physiol Meas. 2011;32:1639–51.CrossRefPubMedPubMedCentral
39.
Connolly M, Vespa P, Hu X. Characterization of cerebral vascular response to EEG bursts using ICP pulse waveform template matching. Acta Neurochir Suppl. 2016;122:291–4.CrossRefPubMed
Metadata
Title
Evaluation of a New Catheter for Simultaneous Intracranial Pressure Monitoring and Cerebral Spinal Fluid Drainage: A Pilot Study
Authors
Xiuyun Liu
Lara L. Zimmermann
Nhi Ho
Paul Vespa
Xiaoling Liao
Xiao Hu
Publication date
01-06-2019
Publisher
Springer US
Published in
Neurocritical Care / Issue 3/2019
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-018-0648-z

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