Review
Critical Care Medicine
Daniel Agustin Godoy, Sergio Brasil, Corrado Iaccarino, Wellingson Paiva, Andres M. Rubiano
Summary: For decades, the management of severe acute brain injury has focused on controlling intracranial hypertension (IH). However, the thresholds for determining IH have changed over time without clear evidence. Recent developments in understanding intracranial content dynamics and monitoring techniques suggest that targeting intracranial compliance (ICC) may be a more reliable approach. This perspective review discusses the concept of intracranial compartmental syndrome (ICCS) and proposes an integrative model for assessing IH and ICC using modern invasive and noninvasive techniques.
Article
Anesthesiology
Sergio Brasil, Gustavo Frigieri, Fabio Silvio Taccone, Chiara Robba, Davi Jorge Fontoura Solla, Ricardo de Carvalho Nogueira, Marcia Harumy Yoshikawa, Manoel Jacobsen Teixeira, Luiz Marcelo Sa Malbouisson, Wellingson Silva Paiva
Summary: This study assessed the correlation between noninvasive intracranial pressure waveforms (NICPW) and invasively measured intracranial pressure (ICP), as well as the prognostic value of NICPW in acute brain-injured patients. The results showed a significant correlation between NICPW and ICP, and the NICPW-derived P2/P1 ratio could predict intracranial hypertension and early death.
JOURNAL OF CLINICAL MONITORING AND COMPUTING
(2023)
Article
Clinical Neurology
Sergio Brasil, Daniel A. Godoy, Wellingson S. Paiva
Summary: Based on recent research, intracranial pressure management based on predetermined thresholds is not accurate, and physicians need to combine other neuromonitoring techniques to comprehensively evaluate patients' neurological conditions.
WORLD NEUROSURGERY
(2023)
Article
Critical Care Medicine
Frank A. Rasulo, Stefano Calza, Chiara Robba, Fabio Silvio Taccone, Daniele G. Biasucci, Rafael Badenes, Simone Piva, Davide Savo, Giuseppe Citerio, Jamil R. Dibu, Francesco Curto, Martina Merciadri, Paolo Gritti, Paola Fassini, Soojin Park, Massimo Lamperti, Pierre Bouzat, Paolo Malacarne, Arturo Chieregato, Rita Bertuetti, Raffaele Aspide, Alfredo Cantoni, Victoria McCredie, Lucrezia Guadrini, Nicola Latronico
Summary: This study evaluated the reliability of transcranial Doppler (ICPtcd) as a screening test for excluding intracranial hypertension. The results showed that ICPtcd has a high negative predictive value and can accurately exclude intracranial hypertension. It can be useful in situations where invasive methods are not available or cannot be used.
Article
Critical Care Medicine
Jennifer C. Laws, E. Haley Vance, Kristina A. Betters, Jessica J. Anderson, Sydney Fleishman, Christopher M. Bonfield, John C. Wellons III, Meng Xu, James C. Slaughter, Dario A. Giuse, Neal Patel, Lori C. Jordan, Michael S. Wolf
Summary: This retrospective observational study assessed the acute effects of ketamine on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children with severe traumatic brain injury (TBI). The results showed that ketamine reduced ICP during ICP crises, but had no significant effect when used for sedation. These findings suggest that ketamine may be considered as a treatment for intracranial hypertension in children with severe TBI.
CRITICAL CARE MEDICINE
(2023)
Article
Neurosciences
Sergio Brasil, Davi Jorge Fontoura Solla, Ricardo de Carvalho Nogueira, Manoel Jacobsen Teixeira, Luiz Marcelo Sa Malbouisson, Wellingson Silva Paiva
Summary: This study aimed to compare the impact of skull defects and decompressive craniectomy (DC) on intracranial pressure pulse waveform (ICPW) features by analyzing the variations in ICPW features under different mean ICP values. The results showed that intracranial compliance was significantly more impaired among decompressive craniectomy patients, although ICPW indicated DC to be protective for further influences of ICP elevations over the brain. The analysis of ICPW may serve as an alternative to real-time intracranial compliance assessment.
Review
Critical Care Medicine
Gregory W. J. Hawryluk, Giuseppe Citerio, Peter Hutchinson, Angelos Kolias, Geert Meyfroidt, Chiara Robba, Nino Stocchetti, Randall Chesnut
Summary: Intracranial pressure (ICP) monitoring is essential in the clinical care of life-threatening brain insults. It helps warn of expanding intracranial mass lesions, prevent or treat herniation events, and facilitate the calculation of cerebral perfusion pressure. However, controversies still exist regarding indications for monitoring, treatment thresholds, and management of intracranial hypertension.
INTENSIVE CARE MEDICINE
(2022)
Review
Biochemistry & Molecular Biology
Guangshan Hao, Pinar Eser, Jun Mo
Summary: Intracranial hypertension is a common phenomenon in patients with aneurysmal subarachnoid hemorrhage and is associated with unfavorable outcomes. Recent research suggests that oxidative stress may play a crucial role in the physio-pathological changes leading to increased intracranial pressure.
Article
Clinical Neurology
Matheus Ballestero, Celeste Dias, Ines Catarina Neves Gomes, Luca Soares Grisi, Rodrigo Augusto Monteiro Cardoso, Edson Luis Zucoloto Junior, Ricardo Santos de Oliveira
Summary: This study aimed to compare the noninvasive Brain4Care system with invasive ICP curve parameters in predicting ICH and functional prognosis in severe TBI. The results showed that the noninvasive parameters were not associated with outcomes or ICH. Conclusion: Brain4Care's noninvasive method showed low specificity and accuracy and cannot be used as the sole means of monitoring ICP in patients with severe TBI.
ACTA NEUROCHIRURGICA
(2023)
Review
Biophysics
Agnieszka Kazimierska, Romain Manet, Alexandra Vallet, Eric Schmidt, Zofia Czosnyka, Marek Czosnyka, Magdalena Kasprowicz
Summary: Continuous monitoring of mean intracranial pressure (ICP) is crucial in neurocritical care. The ability of the cerebrospinal system to buffer changes in volume without substantial increases in ICP, known as cerebrospinal pressure-volume compensation, is important in preventing adverse effects associated with ICP elevation. Current assessment methods are not suitable for brain injured patients. Recent studies have suggested that the ICP pulse waveform may provide information on cerebrospinal compensatory reserve.
PHYSIOLOGICAL MEASUREMENT
(2023)
Review
Chemistry, Multidisciplinary
George R. E. Bradley, Maria Roldan, Panayiotis A. Kyriacou
Summary: This systematic review aimed to predict intracranial pressure (ICP) crises in patients with severe traumatic brain injury (TBI) in order to prevent secondary brain injury and improve patient outcomes. The review identified three effective approaches: long short-term memory (LSTM), Gaussian processes (GP), and logistic regression models, with area under the receiver operating characteristics curve (AUC-ROC) ranging from 0.86 to 0.95. The review also highlighted the lack of consensus on the definition of an ICP crisis, the most clinically relevant prediction horizon, and the clinical intelligibility, improvement of patient care, and ethical concerns of algorithms.
APPLIED SCIENCES-BASEL
(2023)
Review
Clinical Neurology
Gabriela Nagai Ocamoto, Thiago Luiz Russo, Rafaella Mendes Zambetta, Gustavo Frigieri, Cintya Yukie Hayashi, Sergio Brasil, Nicollas Nunes Rabelo, Deusdedit Lineu Spavieri Junior
Summary: Intracranial compliance (ICC) is associated with maintaining stability of intracranial pressure (ICP), but has not been widely translated into clinical practice. Studies have categorized ICC into physiological definition, clinical interpretation, and localization of phenomena. Invasive methods are primarily used to measure ICC, with potential for exploring non-invasive methods further.
FRONTIERS IN NEUROLOGY
(2021)
Article
Computer Science, Information Systems
Hack-Jin Lee, Hakseung Kim, Young-Tak Kim, Kanghee Won, Marek Czosnyka, Dong-Joo Kim
Summary: The study proposed a novel parameter for predicting potentially life-threatening IH events and developed a machine learning model for predicting LTH events. By analyzing the association between LTH parameters and mortality, the model demonstrated reasonable predictive capacity for mortality. The CatBoost model was able to anticipate whether an IH event would progress into an LTH event.
IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS
(2021)
Article
Critical Care Medicine
Luca Bordoni, Baoqiang Li, Sreekanth Kura, David A. Boas, Sava Sakadzic, Leif ostergaard, Sebastian Frische, Eugenio Gutierrez-Jimenez
Summary: The study revealed that elevated intracranial pressure leads to a gradual collapse of cerebral microvasculature, affecting capillary perfusion even before reaching the clinical threshold of intracranial hypertension. Blood pressure and cerebral perfusion pressure are identified as the best predictors for capillary perfusion.
JOURNAL OF NEUROTRAUMA
(2021)
Article
Critical Care Medicine
Sergio Brasil, Ricardo de Carvalho Nogueira, Angela Salomao Macedo Salinet, Marcia Harumy Yoshikawa, Manoel Jacobsen Teixeira, Wellingson Paiva, Luiz Marcelo Sa Malbouisson, Edson Bor-Seng-Shu, Ronney B. Panerai
Summary: This study evaluates the effects of intracranial pressure (ICP) variability on critical closing pressure (CrCP) and resistance-area product (RAP) among patients with acute brain injury (ABI). The results show a strong correlation between changes in ICP and corresponding changes in CrCP. Patients who underwent neurosurgical interventions have elevated cerebrovascular resistance despite increased arterial blood pressure responses.
NEUROCRITICAL CARE
(2023)
Review
Endocrinology & Metabolism
Ronney B. Panerai, Patrice Brassard, Joel S. Burma, Pedro Castro, Jurgen A. H. R. Claassen, Johannes J. van Lieshout, Jia Liu, Samuel Je Lucas, Jatinder S. Minhas, Georgios D. Mitsis, Ricardo C. Nogueira, Shigehiko Ogoh, Stephen J. Payne, Caroline A. Rickards, Andrew D. Robertson, Gabriel D. Rodrigues, Jonathan D. Smirl, David M. Simpson
Summary: This study improved the evaluation method of cerebral autoregulation (CA) by introducing guidelines for data acquisition, analysis, and reporting, and proposed new recommendations to reflect recent advances in the field. The implementation of these recommendations is crucial for improving the reliability and reproducibility of studies.
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
(2023)
Article
Critical Care Medicine
Natalia Vasconcellos de Oliveira Souza, Carolina Rouanet, Davi Jorge Fontoura Solla, Caio Vinicius Barroso de Lima, Caio Augusto de Souza, Flavio Rezende, Maramelia Miranda Alves, Airton Leonardo de Oliveira Manuel, Feres Chaddad Neto, Michel Frudit, Gisele Sampaio Silva
Summary: The study evaluated a multiethnic cohort of aSAH patients and used the VASOGRADE grading scale to predict the risk of cerebral ischemia and functional outcomes. It found that VASOGRADE-Green accurately predicted patients' ischemic risk and favorable recovery outcomes.
NEUROCRITICAL CARE
(2023)
Article
Physiology
Sergio Brasil, Ricardo C. Nogueira, Angela S. M. Salinet, Marcia H. Yoshikawa, Manoel J. Teixeira, Wellingson Paiva, Luiz M. S. Malbouisson, Edson Bor-Seng-Shu, Ronney B. Panerai
Summary: This study found that in patients with acute brain injury, intracranial pressure (ICP) contributes less to cerebral blood flow autoregulation compared to mean arterial blood pressure (MAP). This has implications for the management of arterial blood pressure in neurocritical patients.
AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY
(2023)
Review
Medicine, Research & Experimental
Wellingson Silva Paiva, Emanuele Zippo, Carolina Miranda, Sergio Brasil, Daniel Augustin Godoy, Almir Ferreira De Andrade, Iuri Neville, Gustavo Cartaxo Patriota, Renan Domingues, Manoel Jacobsen Teixeira
Summary: Intracranial hematomas (ICH) are a common condition in neurosurgical and neurological practices, and experimental research has played a fundamental role in understanding the pathophysiology and developing therapeutic interventions. Various animal models have been used to study ICH, including autologous blood or bacterial collagenase injection, inflation of intracranial balloon, and avulsion of cerebral vessels. These models have improved our understanding of intracranial hypertension, neuroinflammation, immunology, and brain hemodynamics, and have contributed to the development of therapeutic strategies.
EXPERIMENTAL AND THERAPEUTIC MEDICINE
(2023)
Article
Anesthesiology
Sergio Brasil, Gustavo Frigieri, Fabio Silvio Taccone, Chiara Robba, Davi Jorge Fontoura Solla, Ricardo de Carvalho Nogueira, Marcia Harumy Yoshikawa, Manoel Jacobsen Teixeira, Luiz Marcelo Sa Malbouisson, Wellingson Silva Paiva
Summary: This study assessed the correlation between noninvasive intracranial pressure waveforms (NICPW) and invasively measured intracranial pressure (ICP), as well as the prognostic value of NICPW in acute brain-injured patients. The results showed a significant correlation between NICPW and ICP, and the NICPW-derived P2/P1 ratio could predict intracranial hypertension and early death.
JOURNAL OF CLINICAL MONITORING AND COMPUTING
(2023)
Article
Critical Care Medicine
Sergio Brasil, Ricardo de Carvalho Nogueira, Angela Salomao Macedo Salinet, Marcia Harumy Yoshikawa, Manoel Jacobsen Teixeira, Wellingson Paiva, Luiz Marcelo Sa Malbouisson, Edson Bor-Seng-Shu, Ronney B. Panerai
Summary: This study evaluates the effects of intracranial pressure (ICP) variability on critical closing pressure (CrCP) and resistance-area product (RAP) among patients with acute brain injury (ABI). The results show a strong correlation between changes in ICP and corresponding changes in CrCP. Patients who underwent neurosurgical interventions have elevated cerebrovascular resistance despite increased arterial blood pressure responses.
NEUROCRITICAL CARE
(2023)
Article
Neurosciences
Adilson Jose Manuel de Oliveira, Nicollas Nunes Rabelo, Joao Paulo Mota Telles, Davi Jorge Fontoura Solla, Antonio Carlos Samaia da Silva Coelho, Guilherme Bitencourt Barbosa, Natalia Camargo Barbato, Marcia Harumy Yoshikawa, Manoel Jacobsen Teixeira, Eberval Gadelha Figueiredo
Summary: This study aimed to investigate if neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with angiographic vasospasm and functional outcome. The results showed that NLR and PLR at admission were not predictive of functional outcome or risk of angiographic vasospasm.
ARQUIVOS DE NEURO-PSIQUIATRIA
(2023)
Editorial Material
Endocrinology & Metabolism
Sergio Brasil, Ronney B. Panerai, Edson Bor-Seng-Shu, Ricardo C. Nogueira
Summary: Cerebral perfusion pressure (CPP), which is commonly used in neurocritical care, is calculated as the difference between mean arterial blood pressure and mean intracranial pressure. This commentary discusses recent physiological advances and bedside practice issues, suggesting that considering CPP under this perspective may lead to inaccurate assumptions and potentially misleading decision making.
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
(2023)
Letter
Critical Care Medicine
Sergio Brasil, Juliana Caldas, Lucy Beishon, Jatinder S. Minhas, Ricardo C. Nogueira
NEUROCRITICAL CARE
(2023)
Article
Critical Care Medicine
Sergio Brasil, Hannah Romeijn, Esther K. Haspels, Wellingson Paiva, Arjen Schaafsma
Summary: This study compares the predictive value of the pulsatile apparent resistance (PaR) index versus the pulsatility index (PI) for intracranial hypertension (ICP > 20 mm Hg) in patients with traumatic brain injury. The results show that the discriminative power of PaR for discriminating intracranial hypertension was superior to PI. PaR seems to be a reliable noninvasive parameter for detecting intracranial hypertension.
NEUROCRITICAL CARE
(2023)
Article
Clinical Neurology
Sergio Brasil, Daniel A. Godoy, Wellingson S. Paiva
Summary: Based on recent research, intracranial pressure management based on predetermined thresholds is not accurate, and physicians need to combine other neuromonitoring techniques to comprehensively evaluate patients' neurological conditions.
WORLD NEUROSURGERY
(2023)
Letter
Clinical Neurology
Sergio Brasil, Daniel Agustin Godoy
ACTA NEUROCHIRURGICA
(2023)
