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

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Attributes	Values
type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	Assessment of Dynamic Intracranial Compliance in Children with Severe Traumatic Brain Injury: Proof-of-Concept
Creator	Clermont, Gilles Clark, Robert Simon, Dennis Wolf, Michael Horvat, Christopher Kochanek, Patrick Rakkar, Jaskaran
Source	PMC
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 CO(2), and standard-of-care neurocritical care monitoring, to develop a method to assess dynamic intracranial compliance. METHODS: Continuous ICP and end-tidal CO(2) (ETCO(2)) data from children with severe TBI were collected after obtaining informed consent in this Institutional Review Board-approved study. An intracranial pressure-PCO(2) Compliance Index (PCI) was derived by calculating the moment-to-moment correlation between change in ICP and change in ETCO(2). As such, “good” compliance may be reflected by a lack of correlation between time-synched changes in ICP in response to changes in ETCO(2), and “poor” compliance may be reflected by a positive correlation between changes in ICP in response to changes in ETCO(2). RESULTS: A total of 978 h of ICP and ETCO(2) 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12028-020-01004-3) contains supplementary material, which is available to authorized users.
has issue date	2020-06-15(xsd:dateTime)
bibo:doi	10.1007/s12028-020-01004-3
has license	no-cc
sha1sum (hex)	57479afe1311a6eb38d0a2e85c6149eeac8caf10
schema:url	https://doi.org/10.1007/s12028-020-01004-3
resource representing a document's title	Assessment of Dynamic Intracranial Compliance in Children with Severe Traumatic Brain Injury: Proof-of-Concept
has PubMed Central identifier	PMC7299131
schema:publication	Neurocrit Care
resource representing a document's body	covid:57479afe1311a6eb38d0a2e85c6149eeac8caf10#body_text
is schema:about of	named entity 'ICP' named entity 'monitoring' named entity 'CPP' named entity 'severe' named entity 'PROOF' named entity 'TRAUMATIC BRAIN INJURY' named entity 'CONCEPT' named entity 'change' named entity 'capitalize' named entity 'intracranial' named entity 'respiratory failure' named entity 'Severe Traumatic Brain Injury' named entity 'TBI' named entity 'PCI' named entity 'TBI' named entity 'correlation' named entity 'hyperventilation' named entity 'PICU' named entity 'PCI' named entity 'intracranial hypertension' named entity 'ETCO' named entity 'mmHg' named entity 'autoregulation' named entity 'CBF' named entity 'correlation' named entity 'PVI' named entity 'TBI' named entity 'cerebral blood vessel' named entity 'minute ventilation' named entity 'osmolar' named entity 'ETCO' named entity 'weaning' named entity 'linear relationship' named entity 'correlation' named entity 'PVI' named entity 'vasodilatation' named entity 'cranial vault' named entity 'CSF' named entity 'GCS' named entity 'intraventricular' named entity 'correlation' named entity 'pediatric' named entity 'PVI' named entity 'CSF' named entity 'CBF' named entity 'ETCO' named entity 'clinical trials' named entity 'Murraysville' named entity 'CSF' named entity 'PCI' named entity 'intracranial hypertension' named entity 'ETCO' named entity 'hypoventilation' named entity 'ETCO' named entity 'neurocritical care' named entity 'weaning' named entity 'TBI' named entity 'titration' named entity 'Pearson's correlation coefficient' named entity 'cardiovascular' named entity 'CSF' named entity 'TBI' named entity 'cerebral vascular' named entity 'TBI' named entity 'subarachnoid hemorrhage' named entity 'Institutional Review Board' named entity 'mmHg' named entity 'UPMC Children's Hospital of Pittsburgh' named entity 'intracranial hypertension' named entity 'ETCO' named entity 'hyperventilation' named entity 'penetrating injury' named entity 'craniotomy' named entity 'metabolic' named entity 'neurocritical care' named entity 'CBF' named entity 'CBF'

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