Safety and Reliability of Bedside, Single Burr Hole Technique for Intracranial Multimodality Monitoring in Severe Traumatic Brain Injury
We aimed to provide a systematic description of our 2-year experience using a standardized bedside, single burr hole approach to intracranial multimodality monitoring (MMM) in patients with severe traumatic brain injury (sTBI), focusing on safety and probe reliability.
We performed this observational cohort study at a university-affiliated, Level I trauma center with dedicated 20-bed neuroscience intensive care unit. We included 43 consecutive sTBI patients who required MMM to guide clinical care based on institutional protocol and had a four-lumen bolt placed to measure intracranial pressure, brain tissue oxygen, regional cerebral blood flow, brain temperature, and intracranial electroencephalography.
sTBI patients were aged 41.6 ± 17.5 years (mean ± SD) and 84% were men. MMM devices were placed at a median of 12.5 h (interquartile range [IQR] 9.0–21.4 h) after injury and in non-dominant frontal lobe in 72.1% of cases. Monitoring was conducted for a median of 97.1 h (IQR 46.9–124.6 h) per patient. While minor hemorrhage, pneumocephalus, or small bone chips were common, only one (2.4%) patient experienced significant hemorrhage related to device placement. Radiographically, device malpositioning was noted in 13.9% of patients. Inadvertent device discontinuation occurred for at least one device in 58% of patients and was significantly associated with the frequency of travel for procedures or imaging. Devices remained in place for > 80% of the total monitoring period and generated usable data > 50% of that time.
A standardized, bedside single burr hole approach to MMM was safe. Despite some probe-specific recording limitations, MMM provided real-time measurements of intracranial pressure, oxygenation, regional cerebral blood flow, brain temperature, and function.
KeywordsNeurocritical care Multimodality monitoring Neuromonitoring Intracranial pressure Traumatic brain injury PbtO2
The authors wish to acknowledge the hard work and expertise of the Neurosurgery Residents and Neurocritical Care Fellows at the University of Cincinnati.
BF and LBN are involved in study concept and design, data collection, data analysis, and manuscript draft. ES collected the data. JMH collected the data and revised the manuscript. NA involved in study concept and manuscript revisions. JAH contributed to study concept and design, and critical manuscript review.
Source of Funding
This work was supported in part by the Office of the Assistant Secretary of Defense for Health Affairs, through the Defense Medical Research and Development Program under Award No. W81XWH-16-2-0020. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense. Funding was also provided by National Institute of Neurological Disorders and Stroke and Mayfield Education and Research Foundation.
Compliance with Ethical Standards
Conflict of interest
There are no competing interests related to this study. Study authors BF, LBN, and JH participate in federally funded clinical and translational research that includes intracranial electroencephalography and multimodality monitoring technologies. BF receives consulting fees from Sage Therapeutics, Inc. and speaking fees from UCB.
This study was approved by the University of Cincinnati’s Institutional Review Board and complied with international standards for clinical research.
Informed consent was not required for this observational study. All devices were used according to their FDA-approved indications.
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