Análise não invasiva da complacência cerebral em comparação a achados tomográficos em pacientes com traumatismo cranioencefálico

Abstract

Intracranial hypertension (ICH) and cerebral compliance alterations are prevalent in traumatic brain injury (TBI) patients and contribute to morbidity and mortality. However, the available monitoring methods are expensive and invasive. This study conducted comparative analyses between tomographic findings and noninvasive measurements of cerebral compliance in TBI patients. This is an analytical, descriptive, and cross-sectional study involving non-surgical TBI patients. Intracranial pressure (ICP) waveform morphology was monitored using a mechanical strain gauge. Brain computed tomography scans (CTs) were classified according to the Marshall scale, and lateral ventricles volumetry was calculated using the 3D Slicer software, during the acute phase of the injury. Statistical comparative analyses were performed between cerebral compliance findings derived from the ICP waveform morphology (P2/P1 ratio and time-to-peak [TTP]) and the Marshall scale classification, cerebral ventricles dimensions, as well as clinical variables such as Glasgow Coma Scale (GCS), pupils’ sizes, mechanical ventilation, sedation, and neurological outcome at the discharge measured by the Glasgow Outcome Scale (GOS). The isolated comparison of cerebral compliance and the cerebral ventricles volume, considering the fixed and random effects of the sample, showed significant results, with a correlation value of -0,181 (IC = 95% [-0,759; 0,355], P < 0,0001) for P2/P1 and volumetry and a correlation value of -0,685 (IC 95% [-2,001; 0,274], P < 0,0001) for TTP and volumetry. Other comparative analyses performed did not reach statistically significant results. This study found an association between noninvasively obtained cerebral compliance variables and the volume of lateral ventricles in the early days after the brain injury.