Noninvasive detection of alarming intracranial pressure changes by auditory monitoring in early management of brain injury: a prospective invasive versus noninvasive study

Fabrice Giraudet, François Longeras, Aurélien Mulliez, Aurélie Thalamy, Bruno Pereira, Paul Avan, Laurent Sakka, Fabrice Giraudet, François Longeras, Aurélien Mulliez, Aurélie Thalamy, Bruno Pereira, Paul Avan, Laurent Sakka

Abstract

Background: In brain-injured patients intracranial pressure (ICP) is monitored invasively by a ventricular or intraparenchymal transducer. The procedure requires specific expertise and exposes the patient to complications such as malposition, hemorrhage or infection. As inner-ear fluid compartments are connected to the cerebrospinal fluid space, ICP changes elicit subtle changes in the physiology of the inner ear. Notably, we previously demonstrated that the phase of cochlear microphonic potential (CM) generated by sound stimuli rotates with ICP. The aim of our study was to validate the monitoring of CM as a noninvasive method to follow ICP.

Methods: Non-invasive measure of CM-phase was compared to ICP recorded invasively in a prospective series of patients with acute brain injury managed in a neuro-intensive care unit. The study focused on patients with varying ICP and normal middle-ear function.

Results: In the 24 patients with less than 4 days of endotracheal ventilation and whose ICP fluctuated (50-hour data), we demonstrated close correlation between CM-phase rotation and ICP (average 1.26 degrees/mmHg). As a binary classifier, CM phase changes of 7-10 degrees signaled 7.5-mmHg ICP increases with a sensitivity of 83% and 19% fallout.

Conclusion: Reference methods to measure ICP require the surgical placement of a pressure transducer. Noninvasive CM-based monitoring of ICP might be beneficial to early management of brain-injured patients with initially preserved consciousness and to the diagnosis of neurological conditions, whenever invasive monitoring cannot be performed.

Trial registration: ClinicalTrials.gov NCT01685476 , registered on 30 August 2012.

Keywords: Cochlear electrophysiology; Intracranial pressure; Noninvasive monitoring.

Figures

Fig. 1
Fig. 1
Characteristics of intracranial pressure (ICP) events and their tracking by cochlear microphonic potential (CM). a Size of ICP events in mmHg. b Duration of ICP events in minutes. c Pearson correlation coefficients (R) describing the CM-phase-to-ICP linear relationship, vertically aligned for every individual ear (stars), with the 95% confidence interval for each of them (bars)
Fig. 2
Fig. 2
Examples of individual time courses of ICP (red, mmHg) and CM phase (blue, degrees). Vertical range: 20 mmHg for ICP in all diagrams; adjusted according to the CM-phase-to-ICP slope, for CM phase (also see Fig. 3a). In every panel labeled from a-i, patient numbers (#n, upper right corners) match those in Fig. 1c, left column. Dashed lines: intervals of time during which data collection was interrupted by a nursing procedure
Fig. 3
Fig. 3
Statistical analysis of cochlear microphonic potential (CM) monitoring outcomes. a linear fits of individual CM-phase to intracranial pressure (ICP) relationships. b Pearson R coefficients against age. c-d Receiver operating characteristic plots of true positive vs fallout of binary classifications based upon a 5-mmHg increase in ICP (c) and a 5-mmHg decrease in ICP (d)

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