Ideta Mylena Miki Lopes, Oliveira Louise Makarem, Gonçalves Daniel Buzaglo, Paschoalino Mylla Christie, Carvalho Nise Alessandra, Della Coletta Marcus Vinicius, Paiva Wellingson, Brasil Sérgio, Amorim Robson Luís Oliveira
Department of Internal Medicine, Federal University of Amazonas, Manaus 69077, ZIP, Brazil.
Department of Neurology, University of São Paulo, Ribeirão Preto 14049, ZIP, Brazil.
Brain Sci. 2023 Feb 25;13(3):401. doi: 10.3390/brainsci13030401.
Due to the importance of not mistaking when determining the brain death (BD) diagnostic, reliable confirmatory exams should be performed to enhance its security. This study aims to evaluate the intracranial pressure (ICP) pulse morphology behavior in brain-dead patients through a noninvasive monitoring system.
A pilot case-control study was conducted in adults that met the BD national protocol criteria. Quantitative parameters from the ICP waveforms, such as the P2/P1 ratio, time-to-peak (TTP) and pulse amplitude (AMP) were extracted and analyzed comparing BD patients and health subjects.
Fifteen patients were included, and 6172 waveforms were analyzed. ICP waveforms presented substantial differences amidst BD patients when compared to the control group, especially AMP, which had lower values in patients diagnosed with BD ( < 0.0001) and the TTP median ( < 0.00001), but no significance was found for the P2/P1 ratio ( = 0.8). The area under curve for combination of parameters on the BD prediction was 0.77.
In this exploratory study, noninvasive ICP waveforms have shown potential as a screening method in patients with suspected brain death. Future studies should be carried out in a larger population.
由于在确定脑死亡（BD）诊断时避免误诊的重要性，应进行可靠的确诊检查以提高其安全性。本研究旨在通过无创监测系统评估脑死亡患者的颅内压（ICP）脉搏形态特征。
对符合BD国家方案标准的成年人进行了一项初步病例对照研究。提取并分析了ICP波形的定量参数，如P2/P1比值、峰值时间（TTP）和脉搏振幅（AMP），并将BD患者与健康受试者进行比较。
纳入了15例患者，分析了6172个波形。与对照组相比，BD患者的ICP波形存在显著差异，尤其是AMP，在诊断为BD的患者中其值较低（<0.0001），TTP中位数也较低（<0.00001），但P2/P1比值无显著差异（=0.8）。BD预测参数组合的曲线下面积为0.77。
在这项探索性研究中，无创ICP波形已显示出作为疑似脑死亡患者筛查方法的潜力。未来应在更大规模人群中开展研究。
