Intracranial Pressure PCO2 Compliance Index
Managing intracranial physiology is essential to achieving positive outcomes for patients with severe traumatic brain injury (TBI), intracranial hemorrhage (ICH), and acute hydrocephalus (AH). Knowledge of intracranial compliance, coupled with measurement of intracranial pressure (ICP), would greatly enhance physiologic monitoring, inform clinicians understanding of patient condition, and identify patients at risk for intracranial hypertension. Despite its potential value to patients and physicians, intracranial compliance is not incorporated in current clinical management because it requires separate invasive monitoring or direct manipulation of the patient’s intracranial space, unnecessarily risking infection, bleeding, or elevated ICP. Patients admitted to neurointensive care units typically receive interventions such as osmotherapies, sedation and paralysis, and blood pressure control, among others; however, the patient’s response to each intervention can only be determined after the fact, and administration of these interventions is often reactionary, after the patient’s ICP passes a critical threshold. There is a pressing need for the ability to assess intracranial compliance in real-time in order to assist a clinician in preemptively administering or discontinuing needed therapeutic interventions.
Description
The new ICP-PCO2 Compliance Index (ICP-PCI) is an algorithm designed to compute intracranial compliance in real-time from standard neurointensive care monitor data. The ICP-PCI provides valuable insight into the capacity of the brain to tolerate minute-to-minute physiologic changes in the brain’s blood supply or cerebrospinal fluid volume and would enable the clinician to predict a patient’s response to any of the aforementioned reactionary therapies. The ICP-PCI integrates continuous ICP measurements and end-tidal CO2 (EtCO2) monitoring to predict intracranial compliance without any additional invasive procedures or devices, enabling treatment optimization for patients with TBI, ICH, and AH without the risks associated with previous monitoring options. The ICP-PCI has the potential to optimize neurocritical care management, greatly reduce neurological morbidity, and save lives.Applications
· Providing clinician decision support when to guide treatment options for neurointensive care patientsAdvantages
· Patients with severe TBI already have ICP monitors and continuous EtCO2 measurements, so no additional invasive procedures or devices are required· Does not rely on invasive and potentially dangerous manipulation of intracranial volume
· Enables preemptive, rather than reactionary, interventions and treatment