Ultrasound non-invasive intracranial pressure assessment in paediatric neurocritical care: a pilot study

Chiara Robba , Danilo Cardim , Marek Czosnyka , Francisco Abecasis , Stefano Pezzato , Silvia Buratti , Andrea Moscatelli , Cristina Sortica , Fabrizio Racca , Paolo Pelosi , Frank Rasulo

Abstract

Background: The assessment of intracranial pressure (ICP) is essential in the management of neurocritical care paediatric patients. The gold standard for invasive ICP is an intraventricular catheter or intraparenchymal microsensor but is invasive and carries some risks. Therefore, a non-invasive method for measuring ICP (nICP) would be desirable especially in the paediatric population. The aim of this study is to assess the relationship between ICP and different ultrasound–based methods in neurocritical care paediatric patients. Methods: Children aged < 16 years with indication for invasive ICP monitoring were prospectively enrolled. The following non-invasive methods were compared with the invasive gold standard: optic nerve sheath diameter ultrasound (ONSD)–derived nICP (nICPONSD); arterial TCD–derived pulsatility index (PIa) and a method based on the diastolic component of the TCD cerebral blood flow velocity and mean arterial blood pressure (nICPFVd). Results: We analysed 107 measurements from 10 paediatric patients. Results from linear regression demonstrated that, among the nICP methods, ONSD has the best correlation with ICP (r = 0.852 (p < 0.0001)). Results from receiving operator curve analysis demonstrated that using a threshold of 15 mmHg, ONSD has and area under the curve (AUC) of 0.94 (95% CI = 0.892–0.989), with best threshold at 3.85 mm (sensitivity = 0.811; specificity = 0.939). Conclusions: Our preliminary results suggested that ONSD ultrasonography presents the best accuracy to assess ICP among the methods studied. Given its non-invasiveness, repeatability and safety, this technique has the potential of representing a valid option as non-invasive tool to assess the risk of intracranial hypertension in the paediatric population.

Author Chiara Robba
Chiara Robba,,
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, Danilo Cardim
Danilo Cardim,,
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, Marek Czosnyka (FEIT / PE)
Marek Czosnyka,,
- The Institute of Electronic Systems
, Francisco Abecasis - [Faculdade de Medicina, Universidade de Lisboa]
Francisco Abecasis,,
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, Stefano Pezzato - [IRCCS Istituto Giannina Gaslini - Ospedale Pediatrico]
Stefano Pezzato,,
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, Silvia Buratti - [IRCCS Istituto Giannina Gaslini - Ospedale Pediatrico]
Silvia Buratti,,
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, Andrea Moscatelli - [IRCCS Istituto Giannina Gaslini - Ospedale Pediatrico]
Andrea Moscatelli,,
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, Cristina Sortica - [Cambridge University Hospitals NHS Foundation Trust]
Cristina Sortica,,
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, Fabrizio Racca - [Pediatric Critical Care]
Fabrizio Racca,,
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, Paolo Pelosi - [Università degli Studi di Genova]
Paolo Pelosi,,
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et al.`
Journal seriesChilds Nervous System, [Child's Nervous System], ISSN 0256-7040, e-ISSN 1433-0350
Issue year2020
Vol36
Pages117-124
Keywords in EnglishOptic nerve sheath diameter, Paediatric, Pulsatility index, Transcranial Doppler
ASJC Classification2700 General Medicine; 2728 Clinical Neurology; 2735 Pediatrics, Perinatology, and Child Health
DOIDOI:10.1007/s00381-019-04235-8
URL https://link.springer.com/content/pdf/10.1007/s00381-019-04235-8.pdf
Languageen angielski
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M.Czosnyka_Ultrasound non-invasive intracranial pressure...pdf 980.74 KB
Score (nominal)70
Score sourcejournalList
ScoreMinisterial score = 70.0, 21-07-2020, ArticleFromJournal
Publication indicators Scopus Citations = 3; Scopus SNIP (Source Normalised Impact per Paper): 2018 = 0.804; WoS Impact Factor: 2018 = 1.327 (2) - 2018=1.347 (5)
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