The Development of a Dashboard to Optimise Neuromonitoring of Paediatric Traumatic Brain Injury Patients in the Intensive Care Unit

Master thesis (2022)

Authors

B.J. Formsma Mechanical Engineering

Contributors

Jan Willem Kuiper Erasmus MC (mentor)
A.C. Schouten Biomechanical Engineering (graduation committee member)
Rogier de Jonge Erasmus MC (graduation committee member)
Eris van Twist Erasmus MC (graduation committee member)
Faculty
Mechanical Engineering, Mechanical Engineering
Copyright: © 2022 Bart Formsma
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Published Date

09-12-2022

Language

English

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Faculty

Mechanical Engineering

Abstract

Introduction Traumatic brain injury (TBI) is a leading cause of childhood morbidity, disability and mortality worldwide. In the treatment of TBI, neuromonitoring is essential to prevent secondary neurological damage. However, the use of neuromonitoring and specifically therapeutic targets is currently limited evidence-based.
Objective The primary objective is to implement suitable neuromonitoring parameters into a novel bedside dashboard for paediatric TBI patients. In addition, basic insights into neuromonitoring parameters between different outcome groups are provided.
Methods Intracranial pressure (ICP), cumulative ICP (ICPcum), cerebral perfusion pressure (CPP), pressure reactivity index (PRx), wavelet transform PRx, optimal CPP (CPPopt), partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), end tidal CO2 (etCO2), temperature and sodium levels were implemented into a dashboard. The parameters (except wPRx) were retrospectively analysed in TBI patients admitted to the paediatric intensive care unit (PICU) of the Erasmus MC- Sophia. Patients were divided into a good (GO) or bad (BO) outcome group. Per outcome group, the mean and 95 % confidence interval or the median and interquartile range of parameters were calculated.
Results A total of 35 patients (24 GO, 11 BO) were included. Significant differences between GO and BO were observed in median PRx (-0.06 [-0.13 – 0.01] vs. 0.17 [-0.05 – 0.39]), median percentage outside of the CPPopt (curve) range (15 % [4 – 26] vs. 30 % [26 – 34]), ICPcum distributions (12.0 mmHg [8.0 – 16.0] vs. 12.0 mmHg [8.5 – 15.5]) and mean sodium levels (146.4 mmol/L (144.5 – 148.3) vs. 151.2 mmol/L (148.6 – 153.8)).
Conclusion In a retrospective analysis, PRx, CPPopt (curve) and ICPcum showed potential to improve prognostication for paediatric TBI and to determine therapeutic targets. Based on our results, we recommend implementing MAP, ICP, ICPcum, CPP alongside CPPopt (curve), and sodium levels in a future neuromonitoring dashboard.