Predicting short-term outcomes in brain-Injured patients: A comprehensive approach with transcranial Doppler and intracranial compliance assessment

Abstract

Abstract Background Neurocritical patients frequently exhibit abnormalities in cerebral hemodynamic (CH) impairment and/or intracranial compliance (ICC), all of which significantly impact their clinical outcomes. Transcranial Doppler (TCD) and the cranial micro-deformation sensor (B4C) are valuable techniques for assessing CH and ICC, respectively. However, there is a scarcity of data regarding the predictive value of these techniques in determining patient outcomes. Methods We prospectively included neurocritical patients undergoing intracranial pressure (ICP) monitoring within the first 5 days of hospital admission for TCD and B4C assessments. Comprehensive clinical data were collected alongside parameters obtained from TCD (including blood velocities, pulsatility index, estimated ICP - eICP and estimated cerebral perfusion pressure - eCPP]) and B4C (measured as the P2/P1 ratio). These parameters were evaluated individually as well as in combination. These parameters were evaluated alone as well as in combinations among them. The short-term outcomes (STO) of interest were the therapy intensity levels (til) for icp management recommended by the SIBICC, as TIL 0 (STO 1), TIL 1–3 (STO 2) and death (STO 3), at the seventh day after last data collection. Results A total of 98 patients were included, with 67% having experienced traumatic brain injury; ICP, P2/P1, and eCPP demonstrated the highest ability to predict early mortality (p = 0.02, p = 0.02, and p = 0.006, respectively). P2/P1 was the only parameter significant for the prediction of STO 1 (p = 0.03). Combining B4C and TCD parameters, the highest areas under the curve (AUC) were 0.85 to predict death (STO 3), using P2/P1 + eCPP, whereas AUC was 0.72 to identify ICP > 20 mmHg using P2/P1 + eICP. Conclusion The combined noninvasive neuromonitoring approach using TCD and B4C demonstrated improved performance in predicting outcomes during the early phase after acute brain injury. Correlation between these parameters and intracranial hypertension was moderate, supporting the role of multimodal neuromonitoring as ancillary information in the ICU. Trial registration NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219