Intracranial compliance in patients with COVID-19: a multicenter observational study

Abstract

Background Patients with severe coronavirus disease-19 (COVID-19) may require the use of invasive mechanical ventilation (MV) for prolonged periods. Aggressive MV parameters have been associated with changes in intracranial pressure (ICP) in patients with acute intracranial disorders. Significant ICP elevation could compromise intracranial compliance (ICC) and cerebrovascular hemodynamics (CVH). However, the effects of these parameters in individuals without neurological disorders have not yet been evaluated.

Objective To evaluate ICC in patients on MV with COVID-19 infection compared to other diagnoses, to better characterize the effects of MV and COVID-19 upon ICC. We also compared between the ICC in patients with COVID-19 who did not require MV and healthy volunteers, to assess the isolated effect of COVID-19 upon ICC.

Methods This was an exploratory, observational study with a convenience sample. The ICC was evaluated with a noninvasive ICP monitoring device. The P2/P1 ratio was calculated by dividing the amplitude of these two points, being defined as “abnormal” when P2 > P1. The statistical analysis was performed using a mixed linear model with random effects to compare the P2/P1 ratio in all four groups on the first monitoring day.

Results A convenience sample of 78 subjects (15 MV-COVID-19, 15 MV non-COVID-19, 24 non-MV-COVID-19, and 24 healthy participants) was prospectively enrolled. There was no difference in P2/P1 ratios between MV patients with and without COVID-19, nor between non-MV patients with COVID-19 and healthy volunteers. However, the P2/P1 ratio was higher in COVID-19 patients with MV use than in those without it.

Conclusion This exploratory analysis suggests that COVID-19 does not impair ICC.

Resumo

Antecedentes Pacientes com doença grave por coronavírus-19 (COVID-19) podem necessitar do uso de ventilação mecânica (VM) invasiva por um período prolongado. Parâmetros agressivos de VM têm sido associados a alterações na pressão intracraniana (PIC) em pacientes com doenças intracranianas agudas. Elevações significativas da PIC podem comprometer a complacência intracraniana (CIC) e a hemodinâmica cerebrovascular (HVC). No entanto, os efeitos desses parâmetros em indivíduos sem doenças neurológicas ainda não foram sistematicamente avaliados.

Objetivo Avaliar a CIC em pacientes em VM com COVID-19 comparados com outros diagnósticos, para melhor caracterizar os efeitos da VM e COVID-19 sobre a CIC. Também foi feita a comparação entre a CIC em pacientes com COVID-19 sem VM e voluntários saudáveis, para avaliar o efeito isolado da COVID-19 sobre a ICC.

Métodos Trata-se de um estudo exploratório, observacional com amostra por conveniência. A CIC foi avaliada com um dispositivo não invasivo de monitoramento da PIC. A relação P2/P1 foi calculada dividindo-se a amplitude desses dois pontos, sendo definida como “anormal” quando P2 > P1. A análise estatística foi realizada usando um modelo linear misto com efeitos aleatórios para comparar a relação P2/P1 nos quatro grupos no primeiro dia de monitoramento.

Resultados Uma amostra de conveniência com 78 voluntários (15 COVID-19 em VM, 15 sem COVID-19 em VM, 24 com COVID em respiração espontânea e 24 saudáveis) foram prospectivamente incluídos. Não houve diferença nas razões P2/P1 entre pacientes em VM com e sem COVID-19, nem entre pacientes sem VM com COVID-19 ou saudáveis. No entanto, a relação P2/P1 foi maior em pacientes com COVID-19 com uso de VM do que naqueles sem.

Conclusão Os dados dessa análise exploratória sugerem que a COVID-19 não prejudica a CIC.

Keywords

COVID-19 - Intracranial Pressure - Hemodynamic Brain Response - Neurophysiological Monitoring

Palavras-chave

COVID-19 - Pressão Intracraniana - Acoplamento Neurovascular - Monitorização Neurofisiológica

Authors' Contributions

AFS: conceptualization, data curation, formal analysis, investigation, methodology, resources, writing – original draft; MBS: data curation, investigation, methodology, writing – original draft; NZC: project administration, resources, supervision, writing – original draft; CYH: formal analysis, funding acquisition, software; GHF: funding acquisition, resources, software; SLSA: resources; supervision; JBCA: project administration, writing – original draft; SR: project administration; resources; FM: investigation, supervision, writing – review and editing; VCV: project administration, supervision; UAPF: resources; TLR: conceptualization, formal analysis; methodology, supervision, visualization, writing – review & editing; GSS: formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, visualization, writing – review & editing.

Support

This study was financed by the Coordination of Superior Level Staff Improvement (CAPES, code 001), São Paulo Research Foundation (2023/00506-3); and Brain4Care Inc.

Trial Registration

This study was registered in the Clinical Trials platform at 31589920.7.1001.5505 on April 27, 2021 ( https://clinicaltrials.gov/ct2/show/NCT04861402 ).

Publication History

Received: 21 July 2023

Accepted: 08 May 2024

Article published online:
09 August 2024

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