Rafaella Mendes Zambetta
PhD student
Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo-Brazil., United States
Disclosure information not submitted.
.jpeg.jpg "Sergio Brasil, MD, PhD photo")
Sergio Brasil, MD, PhD
University of Sao Paulo
Sao Paulo, Brazil
Disclosure information not submitted.
Gabriela Nagai Ocamoto
PhD student
Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo-Brazil., United States
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Cintya Yukie Hayashi
PhD student
Department of Neurology, Medical School, University of São Paulo, São Paulo-Brazil, United States
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Nícollas Nunes Rabelo
PhD
Department of Neurosurgery, UniAtenas Center University, Paracatu, Minas Gerais-Brazil, United States
Disclosure information not submitted.
Thiago Luiz Russo
Professor
Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo-Brazil., United States
Disclosure information not submitted.
Title: Intracranial compliance concepts and assessment at Traumatic Brain Injury: A scoping review
INTRODUCTION: Estimates 69 million people will suffer Traumatic brain injury (TBI) each year worldwide. During the acute brain injury, complementary approaches, such as intracranial pressure (ICP) can be relevant to help therapeutic decisions. Intracranial compliance (ICC) has been studied in neurocritical care to complement ICP interpretation, as well as to anticipate brain function deterioration, improving survival and patients recovery. This study is part of a larger scoping review to map the key concepts of ICC in the critical care literature. This study was additionally designed to characterize the relationship between ICC and ICP, and systematically describe the outcomes that are used to assess ICC with both invasive and noninvasive measurement methods.
Methods: The main question of this study was based on the population: human and animal, concept of compliance or inverse “elastance”, and context: neurocritical care. Thereby, literature searches without a time frame were conducted in several databases using a combination of keywords and descriptors.
Results: 42.851 articles were identified and 77 studies fulfilled the inclusion criteria for TBI. Twenty one studies defined ICC. Most of them reported the concept of compliance related to variations of volume and pressure or its inverse (elastance) mainly in the intracranial compartment. In addition, terms like “accommodation”, “compensation”, “reserve capacity” and “buffering ability” were used to describe the clinical interpretation. In the second part of this review, the techniques (invasive and noninvasive) and outcomes used to measure ICC were described. The most common method used was invasive, representing 79.78% of the studies. The most commonly assessed variables were related to ICP, especially its absolute values or pulse amplitude. ICP waveforms should be better explored, as well as the potential of non-invasive methods, once they may be able to measure different aspects of ICC.
Conclusion: The concepts of ICC provide better understanding about the patient condition. The idea of systems interactions, such as cerebral blood flow, cerebrospinal fluid, and pressure reactivity, complement and support TBI treatment. The combination and validation of invasive and non-invasive measurements methods are required to this population.