Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Neurodynamics Laboratory, Department of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Neurocrit Care. 2024 Jun;40(3):1182-1192. doi: 10.1007/s12028-023-01885-0. Epub 2023 Nov 22.
Intracranial multimodal monitoring (iMMM) is increasingly used for neurocritical care. However, concerns arise regarding iMMM invasiveness considering limited evidence in its clinical significance and safety profile. We conducted a synthesis of evidence regarding complications associated with iMMM to delineate its safety profile. We performed a systematic review and meta-analysis (PROSPERO Registration Number: CRD42021225951) according to the Preferred Reporting Items for Systematic Review and Meta-Analysis and Peer Review of Electronic Search Strategies guidelines to retrieve evidence from studies reporting iMMM use in humans that mention related complications. We assessed risk of bias using the Newcastle-Ottawa Scale and funnel plots. The primary outcomes were iMMM complications. The secondary outcomes were putative risk factors. Of the 366 screened articles, 60 met the initial criteria and were further assessed by full-text reading. We included 22 studies involving 1206 patients and 1434 iMMM placements. Most investigators used a bolt system (85.9%) and a three-lumen device (68.8%), mainly inserting iMMM into the most injured hemisphere (77.9%). A total of 54 postoperative intracranial hemorrhages (pooled rate of 4%; 95% confidence interval [CI] 0-10%; I 86%, p < 0.01 [random-effects model]) was reported, along with 46 misplacements (pooled rate of 6%; 95% CI 1-12%; I 78%, p < 0.01) and 16 central nervous system infections (pooled rate of 0.43%; 95% CI 0-2%; I 64%, p < 0.01). We found 6 system breakings, 18 intracranial bone fragments, and 5 cases of pneumocephalus. Currently, iMMM systems present a similar safety profile as intracranial devices commonly used in neurocritical care. Long-term outcomes of prospective studies will complete the benefit-risk assessment of iMMM in neurocritical care. Consensus-based reporting guidelines on iMMM use are needed to bolster future collaborative efforts.
颅内多模态监测（iMMM）越来越多地用于神经危重症监护。然而，考虑到其在临床意义和安全性方面的证据有限，人们对 iMMM 的侵袭性产生了担忧。我们对与 iMMM 相关的并发症进行了证据综合，以阐明其安全性概况。我们根据系统评价和荟萃分析的首选报告项目以及电子搜索策略同行评审指南进行了系统评价和荟萃分析（PROSPERO 注册号：CRD42021225951），以从报告人类使用 iMMM 并提及相关并发症的研究中检索证据。我们使用纽卡斯尔-渥太华量表和漏斗图评估偏倚风险。主要结局是 iMMM 并发症。次要结局是假定的危险因素。在筛选出的 366 篇文章中，有 60 篇符合初步标准，并通过全文阅读进一步评估。我们纳入了 22 项研究，涉及 1206 名患者和 1434 次 iMMM 放置。大多数研究人员使用螺栓系统（85.9%）和三腔装置（68.8%），主要将 iMMM 插入受伤最严重的半球（77.9%）。共报告了 54 例术后颅内出血（总发生率为 4%；95%置信区间 [CI] 0-10%；I 86%，p<0.01 [随机效应模型]），46 例放置不当（总发生率为 6%；95%CI 1-12%；I 78%，p<0.01）和 16 例中枢神经系统感染（总发生率为 0.43%；95%CI 0-2%；I 64%，p<0.01）。我们发现了 6 例系统故障、18 例颅内骨碎片和 5 例气颅。目前，iMMM 系统的安全性与神经危重症监护中常用的颅内装置相似。前瞻性研究的长期结果将完成 iMMM 在神经危重症监护中的获益-风险评估。需要基于共识的 iMMM 使用报告指南来支持未来的合作努力。
