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Characterization of Shape Differences Among ICP Pulses Predicts Outcome of External Ventricular Drainage Weaning Trial

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Abstract

Background

External ventricular drains (EVD) are widely used to manage intracranial pressure (ICP) and hydrocephalus for aneurysmal subarachnoid hemorrhage (aSAH) patients. After days of use, a decision is made to remove the EVD or replace it with a shunt, involving EVD weaning and CT imaging to observe ventricular size and clinical status. This practice may lead to prolonged hospital stay, extra radiation exposure, and neurological insult due to ICP elevation. This study aims to apply a validated morphological clustering analysis of ICP pulse (MOCAIP) algorithm to detect signatures from the pulse waveform to differentiate an intact CSF circulatory system from an abnormal one during EVD weaning.

Methods

We performed a retrospective study with 50 aSAH patients with reported weaning trial admitted to our institution between 03/2013 and 08/2014. By reviewing clinical notes and pre/post-brain imaging results, 32 patients were determined as having passed the weaning trial and 18 patients as having failed the trial. MOCAIP algorithm was applied to ICP signals to form a series of artifact-free dominant pulses. Finally, pulses with similar mean ICP were identified, and amplitude, Euclidean, and geodesic inter-pulse distances were calculated in a 4-h moving window.

Results

While the traditional measure of mean ICP failed to differentiate the two groups of patients, the proposed amplitude and morphological inter-pulse measures presented significant differences (p ≤ 0.004). Moreover, receiver operating characteristic (ROC) analyses showed their usability to predict the outcome of the EVD weaning trial (AUC 0.85, p < 0.001).

Conclusions

Patients with an impaired CSF system showed a larger mean and variability of inter-pulse distances, indicating frequent changes on the morphology of pulses. This technique may provide a method to rapidly determine if patients will need placement of a shunt or can simply have the EVD removed.

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Notes

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Acknowledgments

The authors wish to thank Annabel Teng and Andrea Villaroman for their support at the different stages of the study. This work was partially supported by the UCSF Middle Career Scientist Award, UCSF Institute for Computational Health Sciences, and R01NS076738.

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Authors and Affiliations

  1. Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA

    Jorge Arroyo-Palacios, Maryna Rudz, Richard Fidler, Yong Bai & Xiao Hu

  2. Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA

    Wade Smith & Nerissa Ko

  3. Department of Neurological Surgery, School of Medicine, University of California, San Francisco, CA, USA

    Xiao Hu

  4. Institute of Computational Health Sciences, University of California, San Francisco, CA, USA

    Xiao Hu

  5. Department of Neurosurgery, School of Medicine, University of California, Los Angeles, CA, USA

    Xiao Hu

  6. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Soojin Park

Authors
  1. Jorge Arroyo-Palacios
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  2. Maryna Rudz
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  3. Richard Fidler
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  4. Wade Smith
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  5. Nerissa Ko
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  6. Soojin Park
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  7. Yong Bai
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  8. Xiao Hu
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Corresponding author

Correspondence to Xiao Hu.

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Arroyo-Palacios, J., Rudz, M., Fidler, R. et al. Characterization of Shape Differences Among ICP Pulses Predicts Outcome of External Ventricular Drainage Weaning Trial. Neurocrit Care 25, 424–433 (2016). https://doi.org/10.1007/s12028-016-0268-4

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  • DOI: https://doi.org/10.1007/s12028-016-0268-4

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