Early Multimodal Neuromonitoring Parameters as Prognostic Factors For Critically Ill Spontaneous ICH Patients

Abstract

Background: Critically ill patients with spontaneous intracerebral hemorrhage (ICH) warrant a recognizable need for further knowledge on stratification, outcome prediction, neurocritical care and early therapeutic withdrawal. Our goal was to analyze the association between early neuromonitoring signals, from the first 48 hours, in ICH patients with an optimal level of care, and six-month functional status. Methods: This is a single-center retrospective observational study. Neuromonitoring signal records and clinical data from ICH patients, admitted to a Neurocritical Care Unit (NCCU), between January 2015 and September 2021 were considered for analysis. Eligibility criteria included adult age, confirmation of ICH by neuroimaging and ≥ 24 hours of neuromonitoring. Six-month functional status was assessed by modified Rankin Scale (mRS) and dichotomized as a cut-off of severe outcome (mRS 5 and 6). Results: A total sample of 65 patients, mostly males with a mean age of 62.6 years, was analysed. During the first 48 hours of NCCU admission, mean Intracranial Pressure (ICP) had no statistically significant difference between groups (p=0.258). Mean cerebrovascular reactivity pressure index (PRx) was significantly higher in the group with the worst outcome (p=0.018), indicating impaired autoregulation. Other PRx-related variables, namely % of time over 0.2 and those also differed significantly between these groups. Mean Cerebral Perfusion Pressure (CPP) was significantly higher in the group with mRS 1-4 (p=0.029), but the difference between real CPP and optimal CPP was higher in the group with the worst outcome (p=0.023). The difference between real CPP and optimal CPP was the neuromonitoring signal which sustained its significance in multivariable analysis when controlled for other factors. Conclusions: ICP probe placement in ICH patients can provide information as well as therapeutic targets. CPP and PRx are two neuromonitoring parameters that may help predict, in the first 48 hours, the functional outcome of critically ill patients with ICH.