Analysis Of ICP Waveform And ICP Derived Parameters Of TBI Patients

With the development of medical technology,treatments based on intracranial pressure(ICP)of traumatic brain injury patients has been wildly accepted.However,nowadays,the understanding of ICP is inadequate and its intrinsic information hasn't been fully recognized.The clinical significance and mechanism of ICP in traumatic brain injury patients needs to be further studied.By establishing the high frequency,long term data collecting and analyzing protocol,we analyzed ICP waveform and ICP derived parameters of traumatic brain injury patients and the underlying mechanism.Currently,there are few specific data collecting and analysing devices that are suitable for clinicians.In order to solve this problem,we established a high frequency,long term data collecting and analyzing protocol,which has several advantages.This system has achieved data collection and automatic analysis for parameters like arterial blood pressure and ICP and has been proven reliable in the long term test.Following the high frequency,long term data collecting and analyzing protocol,we investigated ICP waveform of 50 traumatic brain injury patients,in which not only did we find all the typical waveforms like plateau wave and B wave,but we also found a new kind of wave: the spindle wave.We further analyzed the clinical status and ICP data of the patients who presented spindle wave and found that patients with spindle wave tend to have a higher Glasgow coma scale(GCS)when discharged,a greater proportion of good recovery,a shorter length of stay.Furthermore,compare with the parameters before the onset of spindle wave,the parameters during the time of spindle wave,such as mean ICP,pulse amplitude of ICP,regression of amplitude and pressure coefficient(RAP)showed significant improvement.The results showed that spindle wave in ICP waveform seemed to be associated with a good outcome in traumatic brain injury patients.During spindle wave,physiological parameters like ICP,brain compliance and compensatory capacity showed significant improvement,which may lead to the enhancement of patients' outcome.We further monitored the ICP derived parameters like pressure reactivity index(PRx)of 50 traumatic brain injury patients from NICU.Together with their clinical prognosis,we found that these parameters vary between good prognosis and poor prognosis patients.Compared with good prognosis group,patients in poor prognosis group tend to have higher ICP,PRx and ICP-ABP wave amplitude correlation(IAAC).While their cerebral perfusion pressure(CPP)was lower than control group.It was suggested by multiple logistic regression that ICP and PRx were two risk factors associated with poor outcome in TBI patients.Further analysis showed that ICP dose of poor prognosis group under either threshold(22 mm Hg,DICP22 and 20 mm Hg,DICP20)was higher than good prognosis group.DICP20's area under curve(AUC)of receiver operating characteristic curve(ROC)is 0.70 and DICP22 is 0.71.PRx dose of poor prognosis group under either threshold(0.05,DPRx0.25 and 0.25,DPRx0.05)was higher than good prognosis group.DPRx0.25's AUC of ROC is 0.97 and DPRx0.05 is 0.96.The results revealed that ICP and PRx were two risk factors associated with poor outcome in traumatic brain injury patients;Both ICP dose and PRx dose can help predict TBI patients' death or vegetative state outcome and PRx dose has a relatively higher accuracy.Bases on the previous studies,we monitored the ICP and its related parameters and then analyzed the wavelet entropy of PRx for the first time which combined the advantages of ICP derived parameters analysis and wavelet entropy analysis.The results showed that the wavelet entropy of PRx may be related with the patient outcome.This study analyzed the ICP waveform and ICP derived parameters of traumatic brain injury patients following the high frequency,long term data collecting and analyzing protocol.We found significance of ICP waveform and ICP derived parameters in terms of clinical diagnosis and treatment,which provides novel tactics to analyze ICP data of traumatic brain injury patients.