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Feasibility of non-invasive neuromonitoring in general intensive care patients using a multi-parameter transcranial Doppler approach

  • Original Research
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Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Purpose

To assess the feasibility of Transcranial Doppler ultrasonography (TCD) neuromonitoring in a general intensive care environment, in the prognosis and outcome prediction of patients who are in coma due to a variety of critical conditions.

Methods

The prospective trial was performed between March 2017 and March 2019 Addenbrooke’s Hospital, Cambridge, UK. Forty adult patients who failed to awake appropriately after resuscitation from cardiac arrest or were in coma due to conditions such as meningitis, seizures, sepsis, metabolic encephalopathies, overdose, multiorgan failure or transplant were eligible for inclusion. Gathered data included admission diagnosis, duration of ventilation, length of stay in the ICU, length of stay in hospital, discharge status using Cerebral Performance Categories (CPC). All patients received intermittent extended TCD monitoring following inclusion in the study. Parameters of interest included TCD-based indices of cerebral autoregulation, non-invasive intracranial pressure, autonomic system parameters (based on heart rate variability), critical closing pressure, the cerebrovascular time constant and indices describing the shape of the TCD pulse waveform.

Results

Thirty-seven patients were included in the final analysis, with 21 patients classified as good outcome (CPC 1-2) and 16 as poor neurological outcomes (CPC 3-5). Three patients were excluded due to inadequacies identified in the TCD acquisition. The results indicated that irrespective of the primary diagnosis, non-survivors had significantly disturbed cerebral autoregulation, a shorter cerebrovascular time constant and a more distorted TCD pulse waveform (all p<0.05).

Conclusions

Preliminary results from the trial indicate that multi-parameter TCD neuromonitoring increases outcome-predictive power and TCD-based indices can be applied to general intensive care monitoring.

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Acknowledgements

This study was sponsored by the Cambridge University Hospitals NHS Foundation Trust R&D and led by MSD (IRAS Project ID: 165207).

Funding

This work was supported by Cambridge Commonwealth, European & International Trust Scholarship (University of Cambridge) in the form of Scholarship funding for DC, and NIHR Brain Injury Healthcare Technology Co-operative, Cambridge, UK in the form of equipment funding for DC, LC, and MC. The sponsors had no role in the design or conduct of this manuscript.

Author information

Authors and Affiliations

  1. Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom

    Leanne A. Calviello, Danilo Cardim, Marek Czosnyka & Peter Smielewski

  2. Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Danilo Cardim

  3. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA

    Danilo Cardim

  4. Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland

    Marek Czosnyka

  5. John Farman Intensive Care Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation, Cambridge, United Kingdom

    Jacobus Preller & Anisha Siyal

  6. Department of Neurology and Neurocritical Care Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation, Cambridge, United Kingdom

    Maxwell S. Damian

  7. Department of Neurology and the Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Texas Health Presbyterian Hospital, 7232 Greenville Avenue, 75231, Dallas, Texas, USA

    Danilo Cardim

Authors
  1. Leanne A. Calviello
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  2. Danilo Cardim
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  3. Marek Czosnyka
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  4. Jacobus Preller
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  5. Peter Smielewski
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  6. Anisha Siyal
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  7. Maxwell S. Damian
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Contributions

LC, DC, MC, MSD designed and led the study, performed the statistical analysis, and drafted the first version of the manuscript. All the authors participated in data interpretation, collection, and editing of the first version of the manuscript. All authors approved the final version of the manuscript and authorship requirements have been met.

Corresponding author

Correspondence to Danilo Cardim.

Ethics declarations

Conflict of interest

MC and PS share financial interest in a portion of ICM+ software licensing fees. The remaining authors disclose no conflicts of interest.

Ethics approval

This manuscript complies with all instructions to authors and adhere to ethical guidelines and indicate ethical approvals (IRB) and use of informed consent. The experimental protocol and informed consent were approved by the institutional review board at Addenbrooke’s Hospital, Cambridge University Hospitals Foundation Trust (“Non-invasive multimodal brain monitoring in Clinical Neuroscience”, IRAS ID 165207, REC (IRB) reference 16/LO/1971).

Consent to participate

Informed consent was obtained for all individual participants included in the study. As patients were unable to provide informed consent themselves at the point of inclusion, they were included either by a process of deferred assent by next of kin or of inclusion by professional assent through treating physicians, who were not involved in the trial.

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Calviello, L.A., Cardim, D., Czosnyka, M. et al. Feasibility of non-invasive neuromonitoring in general intensive care patients using a multi-parameter transcranial Doppler approach. J Clin Monit Comput 36, 1805–1815 (2022). https://doi.org/10.1007/s10877-022-00829-x

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  • DOI: https://doi.org/10.1007/s10877-022-00829-x

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