Mariani Lara, Calza Stefano, Gritti Paolo, Zerbi Simone Maria, Russo Emanuele, Deana Cristian, Filippi Dario, Robba Chiara, Caricato Anselmo, Fassini Paola, Dell'Avanzo Giacomo, Viscone Andrea, De Maria Lucio, Pisapia Luca, Vetrugno Luigi, Zona Gianluigi, Stefini Roberto, Iaccarino Corrado, Latronico Nicola, Piva Simone, Bertoni Michele, Biroli Antonio, Fontanella Marco Maria, Rasulo Frank
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Residency School in Anesthesiology and Intensive Care Medicine, University of Brescia, Brescia, Italy.
Crit Care. 2025 Jun 13;29(1):237. doi: 10.1186/s13054-025-05384-w.
The duration of episodes of intracranial hypertension is related to poor outcome, hence the need for prompt diagnosis. Numerous issues can lead to delays in the implementation of invasive intracranial pressure (ICP) monitoring, thereby increasing the dose of intracranial hypertension to which the patient is exposed. The aim of this prospective, observational, multicenter study was to assess the magnitude of this delay, evaluating the time required for initiation of invasive ICP monitoring, from indication (T1) to initiation of the maneuver (T2) when performed by neurosurgeons compared to intensive care physicians.
We evaluated the impact of the operator performing the maneuver (neurosurgeon vs. intensivist) on the T2-T1 time interval, where T1 represents the time at which indication for invasive ICP monitoring is declared, and T2 the time at which the maneuver starts, defined as the skin incision. The effect of the operator performing the maneuver was evaluated through a parametric survival model. Both intraparenchymal catheters (IPCs) and external ventricular drains (EVDs) were considered as invasive ICP monitoring devices. Invasive monitoring could be performed in intensive care unit (ICU) or in operating room (OR).
A total of 112 patients were included into the final analysis; 39 IPCs were placed by intensivists within the ICU, and a total of 73 IPCs and EVDs by neurosurgeons both within the ICU and OR settings. The mean difference in T2-T1 time for IPCs placement in the ICU was 69 min (CI 50.1-94.8) in the intensivist group and 145 min (CI 103.4-202.9) in neurosurgeon group. The mean difference between these groups, 76 min, was found to be statistically significant (p-value = 0.0021). In the group treated by neurosurgeons, no statistically significant differences were found in timing between the ICU and the OR.
Invasive ICP monitoring performed with IPCs in ICU begins earlier when performed by intensivists rather than neurosurgeons. This finding suggests the possibility to obtain a prompt diagnosis of intracranial hypertension when intensivists intervein directly at patient's bedside. Further studies are needed to confirm these findings and investigate their effect on outcome.
颅内高压发作的持续时间与不良预后相关，因此需要及时诊断。许多问题可能导致有创颅内压（ICP）监测的实施延迟，从而增加患者暴露于颅内高压的剂量。这项前瞻性、观察性、多中心研究的目的是评估这种延迟的程度，比较神经外科医生和重症监护医生从指征（T1）到开始操作（T2）进行有创ICP监测所需的时间。
我们评估了进行操作的人员（神经外科医生与重症监护医生）对T2 - T1时间间隔的影响，其中T1代表宣布有创ICP监测指征的时间，T2代表操作开始的时间，定义为皮肤切开时间。通过参数生存模型评估进行操作的人员的影响。脑实质内导管（IPC）和外部脑室引流管（EVD）均被视为有创ICP监测设备。有创监测可在重症监护病房（ICU）或手术室（OR）进行。
共有112例患者纳入最终分析；重症监护医生在ICU内放置了39根IPC，神经外科医生在ICU和OR环境中总共放置了73根IPC和EVD。在ICU放置IPC时，重症监护医生组T2 - T1时间的平均差异为69分钟（CI 50.1 - 94.8），神经外科医生组为145分钟（CI 103.4 - 202.9）。发现这两组之间的平均差异76分钟具有统计学意义（p值 = 0.0021）。在神经外科医生治疗的组中，ICU和OR之间的时间安排未发现统计学上的显著差异。
在ICU中使用IPC进行有创ICP监测时，由重症监护医生进行比神经外科医生开始得更早。这一发现表明，当重症监护医生直接在患者床边进行干预时，有可能及时诊断颅内高压。需要进一步的研究来证实这些发现并调查它们对预后的影响。
