A Multimodal Non-invasive Approach for Intracranial Pressure Assessment: A Single-Center Study

Intracranial pressure (ICP) monitoring is an integral part of acute brain injury management. While invasive ICP monitoring is the gold standard, there are several medical conditions that preclude its placement. The aim of the present study is to validate a multimodal approach for increasing ICP detection.

In this retrospective study, patients with acute brain injury who had an external ventricular drain (EVD) placement were included. We measured bilateral optic nerve sheath diameter (ONSD) and assessed for optic nerve disk elevation (ONDE) by using ocular ultrasound, bilateral middle cerebral artery pulsatility index (PI) by using transcranial Doppler, and assessed pupillary reactivity with or without a pupillometer as part of a multimodal assessment. We assessed the correlation and agreement of these values with the ICP measured by the EVD.

A total of 56 measurements from 40 patients were included. The presence of three or more variables among mean ONSD > 5 mm, unilateral or bilateral presence of ONDE, at least one MCA PI > 1.2, and bilateral unreactive pupils demonstrated excellent specificity (1, 95%CI 0.92 - 1) and positive predictive value (PPV) (1, 95%CI 0.39-1) for association with ICP ≥ 15 mm Hg, with area under receiver operating characteristic curve of 0.84 (95%CI 0.74-0.94).

Non-invasive multimodal assessment can be easily done at the bedside and seems to correlate well with higher ICP.