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Boraschi A, Hafner M, Spiegelberg A, Kurtcuoglu V. Influence of age on the relation between body position and noninvasively acquired intracranial pulse waves. Sci Rep 2024; 14:5493. [PMID: 38448614 PMCID: PMC10918064 DOI: 10.1038/s41598-024-55860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
The capacitive measurement of the head's dielectric properties has been recently proposed as a noninvasive method for deriving surrogates of craniospinal compliance (CC), a parameter used in the evaluation of space-occupying neurological disorders. With the higher prevalence of such disorders in the older compared to the younger population, data on the head's dielectric properties of older healthy individuals would be of particularly high value before assessing pathologic changes. However, so far only measurements on young volunteers (< 30 years) were reported. In the present study, we have investigated the capacitively obtained electric signal known as W in older healthy individuals. Thirteen healthy subjects aged > 60 years were included in the study. W was acquired in the resting state (supine horizontal position), and during head-up and head-down tilting. AMP, the peak-to-valley amplitude of W related to cardiac action, was extracted from W. AMP was higher in this older cohort compared to the previously investigated younger one (0°: 5965 ± 1677 arbitrary units (au)). During head-up tilting, AMP decreased (+ 60°: 4446 ± 1620 au, P < 0.001), whereas it increased during head-down tilting (- 30°: 7600 ± 2123 au, P < 0.001), as also observed in the younger cohort. Our observation that AMP, a metric potentially reflective of CC, is higher in the older compared to the younger cohort aligns with the expected decrease of CC with age. Furthermore, the robustness of AMP is reinforced by the consistent relative changes observed during tilt testing in both cohorts.
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Affiliation(s)
- Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Matthias Hafner
- The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Andreas Spiegelberg
- The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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Cannizzaro LA, Iwuchukwu I, Rahaman V, Hirzallah M, Bodo M. Noninvasive neuromonitoring with rheoencephalography: a case report. J Clin Monit Comput 2023; 37:1413-1422. [PMID: 36934402 PMCID: PMC10024795 DOI: 10.1007/s10877-023-00985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/16/2023] [Indexed: 03/20/2023]
Abstract
Cerebral blood flow (CBF) autoregulation (AR) can be monitored using invasive modalities, such as intracranial pressure (ICP) and arterial blood pressure (ABP) to calculate the CBF AR index (PRx). Monitoring PRx can reduce the extent of secondary brain damage in patients. Rheoencephalography (REG) is an FDA-approved non-invasive method to measure CBF. REGx, a CBF AR index, is calculated from REG and arm bioimpedance pulse waves. Our goal was to test REG for neuromonitoring. 28 measurement sessions were performed on 13 neurocritical care patients. REG/arm bioimpedance waveforms were recorded on a laptop using a bioimpedance amplifier and custom-built software. The same program was used for offline data processing. Case #1: The patient's mean REGx increased from - 0.08 on the first day to 0.44 on the second day, indicating worsening intracranial compliance (ICC) (P < 0.0001, CI 0.46-0.58). Glasgow Coma Scale (GCS) was 5 on both days. Case #2: REGx decreased from 0.32 on the first recording to 0.07 on the last (P = 0.0003, CI - 0.38 to - 0.12). GCS was 7 and 14, respectively. Case #3: Within a 36-minute recording, REGx decreased from 0.56 to - 0.37 (P < 0.0001, 95%, CI - 1.10 to - 0.76). Central venous pressure changed from 14 to 9 mmHg. REG pulse wave morphology changed from poor ICC to good ICC morphology. Bioimpedance recording made it possible to quantify the active/passive status of CBF AR, indicate the worsening of ICC, and present it in real time. REGx can be a suitable, non-invasive alternative to PRx for use in head-injured patients.
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Affiliation(s)
| | | | | | | | - Michael Bodo
- 1Ochsner Medical Center, New Orleans, LA, USA.
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Müller SJ, Henkes E, Gounis MJ, Felber S, Ganslandt O, Henkes H. Non-Invasive Intracranial Pressure Monitoring. J Clin Med 2023; 12:jcm12062209. [PMID: 36983213 PMCID: PMC10051320 DOI: 10.3390/jcm12062209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
(1) Background: Intracranial pressure (ICP) monitoring plays a key role in the treatment of patients in intensive care units, as well as during long-term surgeries and interventions. The gold standard is invasive measurement and monitoring via ventricular drainage or a parenchymal probe. In recent decades, numerous methods for non-invasive measurement have been evaluated but none have become established in routine clinical practice. The aim of this study was to reflect on the current state of research and shed light on relevant techniques for future clinical application. (2) Methods: We performed a PubMed search for “non-invasive AND ICP AND (measurement OR monitoring)” and identified 306 results. On the basis of these search results, we conducted an in-depth source analysis to identify additional methods. Studies were analyzed for design, patient type (e.g., infants, adults, and shunt patients), statistical evaluation (correlation, accuracy, and reliability), number of included measurements, and statistical assessment of accuracy and reliability. (3) Results: MRI-ICP and two-depth Doppler showed the most potential (and were the most complex methods). Tympanic membrane temperature, diffuse correlation spectroscopy, natural resonance frequency, and retinal vein approaches were also promising. (4) Conclusions: To date, no convincing evidence supports the use of a particular method for non-invasive intracranial pressure measurement. However, many new approaches are under development.
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Affiliation(s)
- Sebastian Johannes Müller
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Correspondence: ; Tel.: +49-(0)711-278-34501
| | - Elina Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Matthew J. Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, MA 01655, USA
| | - Stephan Felber
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Stiftungsklinikum Mittelrhein, D-56068 Koblenz, Germany
| | - Oliver Ganslandt
- Neurochirurgische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, D-47057 Duisburg, Germany
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Félix H, Oliveira ES. Non-Invasive Intracranial Pressure Monitoring and Its Applicability in Spaceflight. Aerosp Med Hum Perform 2022; 93:517-531. [DOI: 10.3357/amhp.5922.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: Neuro-ophthalmic findings collectively defined as Spaceflight-Associated Neuro-ocular Syndrome (SANS) are one of the leading health priorities in astronauts engaging in long duration spaceflight or prolonged microgravity exposure. Though multifactorial in etiology,
similarities to terrestrial idiopathic intracranial hypertension (IIH) suggest these changes may result from an increase or impairing in intracranial pressure (ICP). Finding a portable, accessible, and reliable method of monitoring ICP is, therefore, crucial in long duration spaceflight. A
review of recent literature was conducted on the biomedical literature search engine PubMed using the search term “non-invasive intracranial pressure”. Studies investigating accuracy of noninvasive and portable methods were assessed. The search retrieved different methods that
were subsequently grouped by approach and technique. The majority of publications included the use of ultrasound-based methods with variable accuracies. One of which, noninvasive ICP estimation by optical nerve sheath diameter measurement (nICP_ONSD), presented the highest statistical correlation
and prediction values to invasive ICP, with area under the curve (AUC) ranging from 0.75 to 0.964. One study even considers a combination of ONSD with transcranial Doppler (TCD) for an even higher performance. Other methods, such as near-infrared spectroscopy (NIRS), show positive and promising
results [good statistical correlation with invasive techniques when measuring cerebral perfusion pressure (CPP): r = 0.83]. However, for its accessibility, portability, and accuracy, ONSD seems to present itself as the up to date, most reliable, noninvasive ICP surrogate and a valuable spaceflight
asset.Félix H, Santos Oliveira E. Non-invasive intracranial pressure monitoring and its applicability in spaceflight. Aerosp Med Hum Perform. 2022; 93(6):517–531.
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Everitt A, Root B, Calnan D, Manwaring P, Bauer D, Halter R. A bioimpedance-based monitor for real-time detection and identification of secondary brain injury. Sci Rep 2021; 11:15454. [PMID: 34326387 PMCID: PMC8322167 DOI: 10.1038/s41598-021-94600-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/13/2021] [Indexed: 01/01/2023] Open
Abstract
Secondary brain injury impacts patient prognosis and can lead to long-term morbidity and mortality in cases of trauma. Continuous monitoring of secondary injury in acute clinical settings is primarily limited to intracranial pressure (ICP); however, ICP is unable to identify essential underlying etiologies of injury needed to guide treatment (e.g. immediate surgical intervention vs medical management). Here we show that a novel intracranial bioimpedance monitor (BIM) can detect onset of secondary injury, differentiate focal (e.g. hemorrhage) from global (e.g. edema) events, identify underlying etiology and provide localization of an intracranial mass effect. We found in an in vivo porcine model that the BIM detected changes in intracranial volume down to 0.38 mL, differentiated high impedance (e.g. ischemic) from low impedance (e.g. hemorrhagic) injuries (p < 0.001), separated focal from global events (p < 0.001) and provided coarse 'imaging' through localization of the mass effect. This work presents for the first time the full design, development, characterization and successful implementation of an intracranial bioimpedance monitor. This BIM technology could be further translated to clinical pathologies including but not limited to traumatic brain injury, intracerebral hemorrhage, stroke, hydrocephalus and post-surgical monitoring.
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Affiliation(s)
- Alicia Everitt
- Thayer School of Engineering, Dartmouth College, HB 8000, 14 Engineering Dr., Hanover, NH, 03755, USA.
| | - Brandon Root
- Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | - Daniel Calnan
- Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | | | - David Bauer
- Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | - Ryan Halter
- Thayer School of Engineering, Dartmouth College, HB 8000, 14 Engineering Dr., Hanover, NH, 03755, USA.,Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
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Li G, Li W, Chen J, Zhao S, Bai Z, Liu Q, Liao Q, He M, Zhuang W, Chen M, Sun J, Chen Y. Noninvasive real-time assessment of intracranial pressure after traumatic brain injury based on electromagnetic coupling phase sensing technology. BMC Neurol 2021; 21:26. [PMID: 33455585 PMCID: PMC7812649 DOI: 10.1186/s12883-021-02049-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background To investigate the feasibility of intracranial pressure (ICP) monitoring after traumatic brain injury (TBI) by electromagnetic coupling phase sensing, we established a portable electromagnetic coupling phase shift (ECPS) test system and conducted a comparison with invasive ICP. Methods TBI rabbits’ model were all synchronously monitored for 24 h by ECPS testing and invasive ICP. We investigated the abilities of the ECPS to detect targeted ICP by feature extraction and traditional classification decision algorithms. Results The ECPS showed an overall downward trend with a variation range of − 13.370 ± 2.245° as ICP rose from 11.450 ± 0.510 mmHg to 38.750 ± 4.064 mmHg, but its change rate gradually declined. It was greater than 1.5°/h during the first 6 h, then decreased to 0.5°/h and finally reached the minimum of 0.14°/h. Nonlinear regression analysis results illustrated that both the ECPS and its change rate decrease with increasing ICP post-TBI. When used as a recognition feature, the ability (area under the receiver operating characteristic curve, AUCs) of the ECPS to detect ICP ≥ 20 mmHg was 0.88 ± 0.01 based on the optimized adaptive boosting model, reaching the advanced level of current noninvasive ICP assessment methods. Conclusions The ECPS has the potential to be used for noninvasive continuous monitoring of elevated ICP post-TBI. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02049-3.
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Affiliation(s)
- Gen Li
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China.,Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Wang Li
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Jingbo Chen
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Shuanglin Zhao
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Zelin Bai
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Qi Liu
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Qi Liao
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Minglian He
- Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China
| | - Wei Zhuang
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Mingsheng Chen
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Jian Sun
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China. .,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China.
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China. .,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China.
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