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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(06): 551-563
DOI: 10.1055/s-0043-1764411
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The use of noninvasive measurements of intracranial pressure in patients with traumatic brain injury: a narrative review

Avaliação não invasiva da pressão intracraniana em pacientes com traumatismo cranioencefálico: uma revisão narrativa
Bárbara Caroline Dias Faria 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brazil.
,
Luiz Gustavo Guimarães Sacramento 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brazil.
,
André Vitor Rocha Queiroz 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brazil.
,
Fernanda de Andrade Dias Leite 
2   Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brazil.
,
Henrique Lacerda Lage Lopes de Oliveira 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brazil.
,
Thais Yuki Kimura 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brazil.
,
Rodrigo Moreira Faleiro 
1   Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brazil.
2   Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brazil.
3   Hospital João XXIII, Belo Horizonte MG, Brazil.
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Abstract

Background The most frequent cause of death in neurosurgical patients is due to the increase in intracranial pressure (ICP); consequently, adequate monitoring of this parameter is extremely important.

Objectives In this study, we aimed to analyze the accuracy of noninvasive measurement methods for intracranial hypertension (IH) in patients with traumatic brain injury (TBI).

Methods The data were obtained from the PubMed database, using the following terms: intracranial pressure, noninvasive, monitoring, assessment, and measurement. The selected articles date from 1980 to 2021, all of which were observational studies or clinical trials, in English and specifying ICP measurement in TBI. At the end of the selection, 21 articles were included in this review.

Results The optic nerve sheath diameter (ONSD), pupillometry, transcranial doppler (TCD), multimodal combination, brain compliance using ICP waveform (ICPW), HeadSense, and Visual flash evoked pressure (FVEP) were analyzed. Pupillometry was not found to correlate with ICP, while HeadSense monitor and the FVEP method appear to have good correlation, but sensitivity and specificity data are not available. The ONSD and TCD methods showed good-to-moderate accuracy on invasive ICP values and potential to detect IH in most studies. Furthermore, multimodal combination may reduce the error possibility related to each technique. Finally, ICPW showed good accuracy to ICP values, but this analysis included TBI and non-TBI patients in the same sample.

Conclusions Noninvasive ICP monitoring methods may be used in the near future to guide TBI patients' management.

Resumo

Antecedentes A causa mais frequente de morte em pacientes neurocirúrgicos é devido ao aumento da pressão intracraniana (PIC); consequentemente, o monitoramento adequado desse parâmetro é de extrema importância.

Objetivos Avaliar na literatura científica os principais métodos não invasivos de medida da PIC em pacientes com traumatismo cranioencefálico (TCE).

Métodos Os dados foram obtidos na base de dados PubMed, utilizando os seguintes termos: pressão intracraniana, não invasivo, monitoramento, avaliação e medida, resultando em 147 artigos. Os artigos selecionados datam de 1980 a 2021, sendo todos estudos observacionais ou ensaios clínicos, em inglês e especificando a medida da pressão intracraniana em traumatismo cranioencefálico. Ao final da seleção, 21 artigos foram incluídos nesta revisão.

Resultados Foram analisados os seguintes métodos: diâmetro da bainha do nervo óptico (ONSD), pupilometria, doppler transcraniano (TCD), combinação multimodal, complacência cerebral por meio da análise de ondas intracerebrais (ICPW), HeadSense e visual evocado por flashes de luz (FVEP). A pupilometria não se correlacionou com os valores de PIC, enquanto que o monitor HeadSense e o método FVEP parecem ter uma boa correlação, mas os dados de sensibilidade e especificidade desses métodos não estão disponíveis. Os métodos ONSD e TCD mostraram acurácia de boa a moderada quanto aos valores de IPCi, além de bom potencial para detectar hipertensão intracraniana. Ademais, a combinação multimodal pode reduzir a possibilidade de erro relacionado a cada técnica. Por fim, o ICPW apresentou boa acurácia quanto aos valores de ICPi, mas, no estudo analisado, foram incluídos pacientes com e sem TCE em uma mesma amostra.

Conclusões Métodos não invasivos de medição da PIC podem atuar no futuro no manejo de pacientes com TCE como uma potencial ferramenta de triagem para TCE grave e para a detecção de hipertensão intracraniana.

Keywords

Brain Injuries, Traumatic - Intracranial Pressure - Intracranial Hypertension

Palavras-chave

Lesões Encefálicas Traumáticas - Pressão Intracraniana - Hipertensão Intracraniana

Authors' Contributions

BCDF: is the main author and she reviewed the literature, did selection of articles and data extraction, evaluated the quality of selected articles and wrote the first draft and the final version of manuscript; LGGS: did literature revision, selection of articles and data extraction, evaluated the quality of selected articles and wrote the first draft; AVRQ, FADL, HLLLO, TYK: contributed equally with the manuscript by helping to review and select papers, and writing parts of the manuscript; RMF: reviewed the manuscript and approved its final version.




Publication History

Received: 26 July 2022

Accepted: 23 October 2022

Article published online:
28 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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