Neuromonitoring Using Neurosonography and Pupillometry in A Weaning and Early Neurorehabilitation Unit.

Siepen, Bernhard M.; Grubwinkler, Stephan; Wagner, Andrea; Gruber, Christine; Dickopf, Alexander; Linker, Ralf A; Schlachetzki, Felix; Baldaranov, Dobri (2020). Neuromonitoring Using Neurosonography and Pupillometry in A Weaning and Early Neurorehabilitation Unit. Journal of neuroimaging, 30(5), pp. 631-639. Wiley 10.1111/jon.12742

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BACKGROUND AND PURPOSE

Long-term surveillance of intracranial pressure (ICP) in neurological/neurosurgical patients during ventilator weaning and early neurorehabilitation currently relies on clinical observation because neuroimaging is rarely readily available. In this prospective study, multimodal neurosonography and pupillometry are evaluated for follow-up monitoring.

METHODS

Sonographic neuromonitoring was used to noninvasively examine patients' ICP during weaning and early neurorehabilitation. It allowed assessments of third ventricle width, possible midline shift, middle cerebral artery flow velocities, and bilateral optic nerve sheath diameters. Quantitative pupillometry was used to determine pupil size and reactivity. Other neuroimaging findings, spinal tap ICP measurements, and clinical follow-up data served as controls.

RESULTS

Seventeen patients-11 suffering from intracranial hemorrhage, four from encephalopathies, and two from ischemic stroke-were examined for ICP changes by using neurosonography and pupillometry during a mean observation period of 21 days. In total, 354 of 980 analyses (36.1%) yielded pathological results. In 15 of 17 patients (88.2%), pathological values were found during follow-up without a clear clinical correlate. In two patients (11.8%), clinically relevant changes in ICP occurred and were identified using neurosonography. Abnormal pupillometry findings displayed a high predictive value for absent clinical improvement.

CONCLUSION

Multimodal neurosonography may be a noninvasive means for long-term ICP assessment, whereas pupillometry may only detect rapid ICP changes during acute neurointensive care. The study also illustrates common pitfalls in neuromonitoring in general, with large numbers of pathological albeit nonsignificant findings. Additional controlled studies should validate the influence of detected subtle changes in ICP on neurological outcome.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Siepen, Bernhard Matthias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1051-2284

Publisher:

Wiley

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

10 Nov 2020 11:23

Last Modified:

10 Nov 2020 11:23

Publisher DOI:

10.1111/jon.12742

PubMed ID:

32592294

Uncontrolled Keywords:

Intracranial pressure neuromonitoring neurorehabilitation optic nerve sheath diameter pupillometry

BORIS DOI:

10.7892/boris.147370

URI:

https://boris.unibe.ch/id/eprint/147370

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