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01-02-2021 | Central Nervous System Trauma | Original Work

Assessment of Dynamic Intracranial Compliance in Children with Severe Traumatic Brain Injury: Proof-of-Concept

Authors: Michael S. Wolf, Jaskaran Rakkar, Christopher M. Horvat, Dennis W. Simon, Patrick M. Kochanek, Gilles Clermont, Robert S. B. Clark

Published in: Neurocritical Care | Issue 1/2021

Abstract

Background and Aims

Intracranial compliance refers to the relationship between a change in intracranial volume and the resultant change in intracranial pressure (ICP). Measurement of compliance is useful in managing cardiovascular and respiratory failure; however, there are no contemporary means to assess intracranial compliance. Knowledge of intracranial compliance could complement ICP and cerebral perfusion pressure (CPP) monitoring in patients with severe traumatic brain injury (TBI) and may enable a proactive approach to ICP management. In this proof-of-concept study, we aimed to capitalize on the physiologic principles of intracranial compliance and vascular reactivity to CO₂, and standard-of-care neurocritical care monitoring, to develop a method to assess dynamic intracranial compliance.

Methods

Continuous ICP and end-tidal CO₂ (ETCO₂) data from children with severe TBI were collected after obtaining informed consent in this Institutional Review Board-approved study. An intracranial pressure-PCO₂ Compliance Index (PCI) was derived by calculating the moment-to-moment correlation between change in ICP and change in ETCO₂. As such, “good” compliance may be reflected by a lack of correlation between time-synched changes in ICP in response to changes in ETCO₂, and “poor” compliance may be reflected by a positive correlation between changes in ICP in response to changes in ETCO₂.

Results

A total of 978 h of ICP and ETCO₂ data were collected and analyzed from eight patients with severe TBI. Demographic and clinical characteristics included patient age 7.1 ± 5.8 years (mean ± SD); 6/8 male; initial Glasgow Coma Scale score 3 [3–7] (median [IQR]); 6/8 had decompressive surgery; 7.1 ± 1.4 ICP monitor days; ICU length of stay (LOS) 16.1 ± 6.8 days; hospital LOS 25.9 ± 8.4 days; and survival 100%. The mean PCI for all patients throughout the monitoring period was 0.18 ± 0.04, where mean ICP was 13.7 ± 2.1 mmHg. In this cohort, PCI was observed to be consistently above 0.18 by 12 h after monitor placement. Percent time spent with PCI thresholds > 0.1, 0.2, and 0.3 were 62% [24], 38% [14], and 23% [15], respectively. The percentage of time spent with an ICP threshold > 20 mmHg was 5.1% [14.6].

Conclusions

Indirect assessment of dynamic intracranial compliance in TBI patients using standard-of-care monitoring appears feasible and suggests a prolonged period of derangement out to 5 days post-injury. Further study is ongoing to determine if the PCI—a new physiologic index, complements utility of ICP and/or CPP in guiding management of patients with severe TBI.

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Title: Assessment of Dynamic Intracranial Compliance in Children with Severe Traumatic Brain Injury: Proof-of-Concept
Authors: Michael S. Wolf
Jaskaran Rakkar
Christopher M. Horvat
Dennis W. Simon
Patrick M. Kochanek
Gilles Clermont
Robert S. B. Clark
Publication date: 01-02-2021
Publisher: Springer US
Keywords: Central Nervous System Trauma
Intracranial Hypertension
Published in: Neurocritical Care / Issue 1/2021
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-020-01004-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of Dynamic Intracranial Compliance in Children with Severe Traumatic Brain Injury: Proof-of-Concept

Abstract

Background and Aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and Aims

Methods

Results

Conclusions

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