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 ...

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