Neurocritical care · 2026
Utilization of Noninvasive Intracranial Pressure Monitoring in Patients with Traumatic Brain Injury Treated in Low-Resource Settings: The Intrigo Study.
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Picetti Edoardo, Taccone Fabio Silvio, Adeleye Amos O, Brasil Sérgio, Godoy Daniel A, Prabhakar Hemanshu, Rubiano Andres M, Shrestha Gentle S, Tirsit Abenezer, Videtta Walter, Robba Chiara
Аннотация
BACKGROUND: Invasive intracranial pressure (ICP) monitoring is not universally available in low-resource settings, mainly owing to high costs. In this scenario, noninvasive ICP (nICP) estimation could be integrated in therapeutic protocols. The objective of this international survey was to describe the utilization of nICP monitoring in this setting.
METHODS: The survey comprised 23 items. Target respondents were doctors treating patients with severe traumatic brain injury (TBI) in low-resource settings without the availability of invasive ICP monitoring.
RESULTS: In total, 126 physicians from 114 centers among 21 countries worldwide responded. The main findings of this study were: (a) a predominant use of optic nerve sheath diameter (ONSD) as nICP assessment tool; (b) the utilization of at least two methods for nICP estimation in approximately half of the cases; and (c) the absence of specific protocol for nICP monitoring. We also reported a certain degree of variability regarding the parameters suggestive of intracranial hypertension for each of the methods used.
CONCLUSIONS: Brain ultrasounds, particularly ONSD assessment, are the most frequently utilized tools for nICP estimation in patients with TBI managed in low-resource settings worldwide. Educational efforts linked with protocols development could be a step forward to improve the care of TBI in resource-limited settings, but further studies in this field are necessary.
METHODS: The survey comprised 23 items. Target respondents were doctors treating patients with severe traumatic brain injury (TBI) in low-resource settings without the availability of invasive ICP monitoring.
RESULTS: In total, 126 physicians from 114 centers among 21 countries worldwide responded. The main findings of this study were: (a) a predominant use of optic nerve sheath diameter (ONSD) as nICP assessment tool; (b) the utilization of at least two methods for nICP estimation in approximately half of the cases; and (c) the absence of specific protocol for nICP monitoring. We also reported a certain degree of variability regarding the parameters suggestive of intracranial hypertension for each of the methods used.
CONCLUSIONS: Brain ultrasounds, particularly ONSD assessment, are the most frequently utilized tools for nICP estimation in patients with TBI managed in low-resource settings worldwide. Educational efforts linked with protocols development could be a step forward to improve the care of TBI in resource-limited settings, but further studies in this field are necessary.