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Ultrasound non-invasive intracranial pressure assessment in paediatric neurocritical care: a pilot study

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Abstract

Background

The assessment of intracranial pressure (ICP) is essential in the management of neurocritical care paediatric patients. The gold standard for invasive ICP is an intraventricular catheter or intraparenchymal microsensor but is invasive and carries some risks. Therefore, a non-invasive method for measuring ICP (nICP) would be desirable especially in the paediatric population. The aim of this study is to assess the relationship between ICP and different ultrasound–based methods in neurocritical care paediatric patients.

Methods

Children aged < 16 years with indication for invasive ICP monitoring were prospectively enrolled. The following non-invasive methods were compared with the invasive gold standard: optic nerve sheath diameter ultrasound (ONSD)–derived nICP (nICPONSD); arterial TCD–derived pulsatility index (PIa) and a method based on the diastolic component of the TCD cerebral blood flow velocity and mean arterial blood pressure (nICPFVd).

Results

We analysed 107 measurements from 10 paediatric patients. Results from linear regression demonstrated that, among the nICP methods, ONSD has the best correlation with ICP (r = 0.852 (p < 0.0001)). Results from receiving operator curve analysis demonstrated that using a threshold of 15 mmHg, ONSD has and area under the curve (AUC) of 0.94 (95% CI = 0.892–0.989), with best threshold at 3.85 mm (sensitivity = 0.811; specificity = 0.939).

Conclusions

Our preliminary results suggested that ONSD ultrasonography presents the best accuracy to assess ICP among the methods studied. Given its non-invasiveness, repeatability and safety, this technique has the potential of representing a valid option as non-invasive tool to assess the risk of intracranial hypertension in the paediatric population.

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Acknowledgements

DC and MC are partially financially supported by NIHR BRC Cambridge, UK, and DC is financially supported by a Cambridge Commonwealth European & International Trust scholarship. For the remaining authors, none was declared.

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Authors and Affiliations

  1. Neurosciences Critical Care Unit, Addenbrooke’s Hospital, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK

    Chiara Robba

  2. Department of Anaesthesia and Intensive Care, S. Policlinico Martino Hospital, IRCCS for Oncology and Neuroscience, University of Genova, Genoa, Italy

    Chiara Robba & Paolo Pelosi

  3. Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Danilo Cardim & Marek Czosnyka

  4. Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada

    Danilo Cardim

  5. Institute of Electronic Systems, Warsaw University of Technology, Warszawa, Poland

    Marek Czosnyka

  6. Paediatric Intensive Care Unit, Centro Hospitalar Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

    Francisco Abecasis

  7. Neonatal and Pediatric Intensive Care Unit, Istuto G. Gaslini Children’s Hospital, Genoa, Italy

    Stefano Pezzato, Silvia Buratti & Andrea Moscatelli

  8. Neonatal Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Cristina Sortica

  9. Pediatric Critical Care, S Antonio Cesare Arrigo Biagio, Alessandria, Italy

    Fabrizio Racca

  10. Department of Intensive Care, Spedali Civili Brescia, Brescia, Italy

    Frank Rasulo

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  1. Chiara Robba
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  2. Danilo Cardim
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Correspondence to Chiara Robba.

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Robba, C., Cardim, D., Czosnyka, M. et al. Ultrasound non-invasive intracranial pressure assessment in paediatric neurocritical care: a pilot study. Childs Nerv Syst 36, 117–124 (2020). https://doi.org/10.1007/s00381-019-04235-8

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