Intracranial compliance in patients with COVID-19: a multicenter observational study

Area of Science:

• Neurology
• Critical Care Medicine
• Pulmonology

Background:

• Severe COVID-19 often necessitates invasive mechanical ventilation (MV), potentially impacting intracranial pressure (ICP) and intracranial compliance (ICC).
• Previous studies linked aggressive MV parameters to ICP changes in neurological disorders, but effects in non-neurological patients remained unevaluated.
• Understanding MV's impact on ICC in COVID-19 is crucial for managing critically ill patients.

Purpose of the Study:

• To compare ICC in mechanically ventilated COVID-19 patients versus other diagnoses.
• To assess the isolated effect of COVID-19 on ICC by comparing non-MV COVID-19 patients to healthy controls.
• To characterize the combined effects of MV and COVID-19 on intracranial compliance.

Main Methods:

• An exploratory, observational study utilizing a convenience sample of 78 participants.
• Intracranial compliance (ICC) assessed noninvasively using a P2/P1 ratio, where P2 > P1 indicates abnormal ICC.
• Statistical analysis employed mixed linear models with random effects to compare ICC across four groups: MV-COVID-19, MV non-COVID-19, non-MV COVID-19, and healthy controls.

Main Results:

• No significant difference in P2/P1 ratios was found between MV COVID-19 and MV non-COVID-19 patients.
• Similarly, no difference in P2/P1 ratios was observed between non-MV COVID-19 patients and healthy volunteers.
• COVID-19 patients requiring MV exhibited higher P2/P1 ratios compared to COVID-19 patients not on MV.

Conclusions:

• This study suggests that COVID-19 infection itself does not inherently impair intracranial compliance (ICC).
• The findings indicate that mechanical ventilation may influence ICC in COVID-19 patients, irrespective of the underlying diagnosis.
• Further research is warranted to fully elucidate the complex interplay between COVID-19, mechanical ventilation, and cerebrovascular hemodynamics.