Name: a detailed protocol for physiological parameters acquisition and analysis in neurosurgical critical patients
Uploaded: 2017-10-17T13:00:00
Description: Watch this Scientific Journal Video about A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients at JoVE.com

We would like to acknowledge all the colleagues in the NICU for their work.

This protocol was approved by the Institutional Review Board of Renji Hospital, Shanghai Jiaotong University School of Medicine.
1. Preparation of the Patient
NOTE: ICP sensor is placed in the patient by a surgical operation (Figure 1). The sensor is placed in the epidural space, subdural space, parenchyma, or ventricular system.
<ol>
	<li>Connect the ICP monitoring machine with the bedside monitor via a specific communication cable.<...

<ol>
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This aim of this article is to introduce the new multimodality monitoring and analyzing system for neurosurgical critical patients, which can be used to monitor physiological parameters, analyze the current clinical status and, hopefully, predict the prognosis of the neurosurgical critical patients. Nowadays, the focus of ICP monitoring is mainly on the mean ICP value while ignoring other parameters, which may carry risks of inaccuracy or delay4,5,<sup...

ICP monitoring is widely used to evaluate intracranial status in neurosurgery department, especially in neurosurgical critical patients1,2,3. Besides mean ICP value, the ICP derived parameters such as ICP waveform, AMP, RAP, PRx, IAAC, and so on, can reflect the status of intracerebral circulation, cerebrospinal compensatory reserve, and brain compliance4,5,6,7,8,9,10,11,12,13. They can be indicative of impending neurological deterioration and even outcome of patients14,15,16,17,18. They can also be used as guidance of proper treatment19. However, most of the clinicians focus only on the mean ICP value while ignoring these parameters. This is partly because there are few specific devices that are suitable for clinicians in their daily clinical work.
To address these drawbacks, we have recently developed a multimodality monitoring system. We use an automatic data collecting and storing device to continuously acquire patients&#39; physiological information such as blood pressure, ICP, and oxygen saturation, and analyze these physiological parameters in order to reveal the current clinical status and, hopefully, predict the prognosis of the neurosurgical critical patients. This multimodality monitoring system has several advantages: (1) it can collect real-time data at high frequency, (2) it can record multiple parameters, i.e., ICP waveform, PRx, RAP, and IAAC, (3) it can achieve long term continuous monitoring, and (4) it is portable and easy to learn.
The objective of this article, therefore, is to show a detailed method of how to use the multimodality monitoring system to record various physiological parameters in neurosurgical critical patients.

<table style="border-collapse:collapse;width:639pt" width="852">
	<colgroup>
		<col style="width:136pt" width="181" />
		<col style="width:171pt" width="228" />
		<col style="width:134pt" width="179" />
		<col style="width:198pt" width="264" />
	</colgroup>
	<tbody>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="width:136pt;height:15.75pt" width="181">Bedside monitor</td>
			<td style="width:171pt" width="228">Philips</td>
			<td style="width:134pt" width="179">IntelliVue MP40 M8003A</td>
			<td style="width:198pt" width="264">With interfacing module</td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">ICP monitoring machine</td>
			<td>&#160;Johnson &#38; Johnson or Sophysa</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">Arterial cannula</td>
			<td>BD</td>
			<td>REF682245</td>
			<td></td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">Pressure transducer</td>
			<td>Haisheng Medical</td>
			<td>DBPT-0103</td>
			<td></td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">Data collection device</td>
			<td>Shanghai Haoju</td>
			<td>Neumatic</td>
			<td></td>
		</tr>
		<tr height="21" style="height:15.75pt">
			<td height="21" style="height:15.75pt">Computer</td>
			<td></td>
			<td></td>
			<td>Requires Windows operating system</td>
		</tr>
	</tbody>
</table>

a detailed protocol for physiological parameters acquisition and analysis in neurosurgical critical patients

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ICP waveform, amplitude of pulse (AMP), the correlation of ICP amplitude and ICP mean (RAP), pressure reactivity index (PRx), ICP and arterial blood pressure (ABP) wave amplitude correlation (IAAC), and so on, can reflect intracranial status, predict prognosis, and can also be used as guidance of proper treatment. However, most of the clinicians focus only on the mean ICP value while ignoring these parameters because of the limitations of the current devices. We have recently developed a multimodality monitoring system to address these drawbacks. This portable, user-friendly system will use a data collecting and storing device to continuously acquire patients&#39; physiological parameters first, i.e., ABP, ICP, and oxygen saturation, and then analyze these physiological parameters. We hope that the multimodality monitoring system will be accepted as a key measure to monitor physiological parameters, to analyze the current clinical status, and to predict the prognosis of the neurosurgical critical patients.

This new multimodality monitoring system was applied on 22 neurosurgical critical patients (15 males). 12 of them (54.55%) had suffered from traumatic brain injury (TBI), 9 of them (40.91%) had intracranial hemorrhage and 1 of them (4.55%) had severe cerebral infarction. The total monitoring time is more than 1,900 h (about 88 h per patient). After successful surgery, we continuously monitored and analyzed their ICP, BP, CPP, PRx, RAP, and IAAC. Figure 3 show...

Watch this Scientific Journal Video about A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients at JoVE.com

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Recently, we have developed a portable multimodality monitoring system for the monitoring of various physiological parameters in neurosurgical critical patients. Detailed protocols on how to use this multimodality monitoring system are presented here.

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ...

The overall goal of this procedure is to acquire and analyze multiple physiological parameters in neurosurgical critical patients. This method can help answer key questions in clinical data monitoring and analysis of yield such as mean Icp value, ABP and Icp derived parameters. The main advantage of this technique is that it can be each achieve long-term, high-frequency monitor data acquisition and analysis.We first had the idea for this method when we were trying to collect and analyze critical neurosurgical patients'long-term continuous physiological data and realized that there are few specific devices that a simple for clinicians in their daily clinical work. Begin by connecting the Icp monitoring machine with the bedside monitor via a specific communication cable. Adjust the reference in the patient's bedside monitor so that the data from the bedside monitor are in accordance with the Icp monitoring machine.Perform an arterial line placement on the patient's left or right radial artery. Next connect the arterial line with the baroreceptor. Then connect the pressure transducer with the patient's bedside monitor via a communication cable.Finally, zero adjust the bedside monitor so that the measured blood pressure coincides with the actual value. Begin by connecting the patient's bedside monitor with the data collecting and storing device via a network cable. Press the power button to turn on the data collecting device.Next, enter the patient's information including the name, ID, diagnosis and initial Glasgow Coma Scale, or GCS. Click the save and start monitoring button to start data collecting and storing. Finally, click the turn off button on the screen at the end of the data acquisition and enter the final GCS.First, dump the stored data to a U disc through universal serial bus interfaces, or USB, on the host. Then, enter a username and password to log into the analysis server. Click the Create New Record button and select the data file in the U disk to start uploading.Then, wait for around 10 to 20 minutes before the data are analyzed, depending on the size of the data file. Next, click on the Detail button of each record to see the results. Click on the chart viewing to see the final diagram.Drag the timeline to see more detail. Finally, click the Scattergram button to see the distribution of the parameters. This new multimodal monitoring and analyzing system is capable of recording and plotting key parameters of the neurosurgical critical patient.As the timeline is adjusted, more detail can be shown for each parameter. Further, this system can analyze the relationship between any two parameters, for example, Icp and PRx, as shown here. This patient's PRx has a variation from minus 0.7 to one and the lowest PRx is reached when his Icp is 10 millimeters of mercury.While attempting this procedure, it is important to remember to perform the zero adjustment properly to ensure that the data collected coincides with actual value. After its development, this technique paved the way for clinicians in neurosurgical critical care units department to monitor physiological parameters, analyze the current clinical status and predict the prognosis in neurosurgical critical patients. After watching this video, you should have a good understanding of how to acquire and analyze multiple physiological parameters in neurosurgical critical patients.

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