Korean J Neurotrauma.  2016 Apr;12(1):28-33. 10.13004/kjnt.2016.12.1.28.

Early Experience of Automated Intraventricular Type Intracranial Pressure Monitoring (LiquoGuard®) for Severe Traumatic Brain Injury Patients

• Kwon YS
• Lee YH
• Cho JM

• KMID: 2163012
• DOI: http://doi.org/10.13004/kjnt.2016.12.1.28

Abstract

OBJECTIVE
The LiquoGuard® system is a new ventricular-type monitoring device that facilitates intracranial pressure (ICP)-controlled or volume-controlled drainage of cerebrospinal fluid (CSF). The purpose of this study is to report the authors' experience with the LiquoGuard® ICP monitoring system, as well as the clinical safety, usefulness, and limitations of this device in the management of patients with traumatic brain injury (TBI).
METHODS
Intraventricular ICP monitoring was performed on 10 patients with TBI using the LiquoGuard® monitoring system. ICP measurements, volume of drained CSF, and clinical outcomes were analyzed and discussed.
RESULTS
ICP monitoring was performed on 10 patients for a mean duration of 6.9 days. With a mean 82,718 records per patient, the mean initial ICP was 16.4 mm Hg and the average ICP across the total duration of monitoring was 15.5 mm Hg. The mean volume of drained CSF was 29.2 cc/day, with no CSF drained in 4 patients. Seven of 10 patients showed 1 or 2 episodes of abnormal ICP measurements. No patient exhibited complications associated with ICP monitoring.
CONCLUSION
The LiquoGuard® system is a versatile tool in the management of TBI patients. Its use is both reliable and feasible for ICP monitoring and therapeutic drainage of CSF. However, episodes of abnormal ICP measurements were frequently observed in patients with slit ventricles, and further study may be needed to overcome this issue.

Keyword

Intracranial pressure; Monitoring, physiologic; Injections, intraventricular; Cerebrospinal fluid leak; Brain injuries

MeSH Terms

Brain Injuries*
Cerebrospinal Fluid
Drainage
Humans
Injections, Intraventricular
Intracranial Pressure*
Monitoring, Physiologic

Figure

• 

  FIGURE 1 A: Main console of the LiquoGuard® intracranial pressure (ICP) monitoring system. A fluid pump regulates the flow of cerebrospinal fluid (CSF) in a closed system. B: The external transducer of the LiquoGuard® system. It is connected to the external ventricular drainage (EVD) catheter and attached to the patient at the level of foramen of Monro. C: Computed tomography scan of a 20-year-old male patient with explosive blast injury. Due to diffuse brain swelling and compressed ventricles, neuronavigation was used for EVD catheter insertion. The distal end of the EVD catheter is placed in an intraventricular location for adequate ICP monitoring and CSF drainage.

• 

  FIGURE 2 Exemplary graph showing the intracranial pressure (ICP) measurements of an 18-year-old female patient with traumatic subdural hematoma. A sudden drop in ICP measurements is noted which may be caused by a slit ventricle. Measurements returned spontaneously to reasonable values.

Reference

1. Açikbaş SC, Akyüz M, Kazan S, Tuncer R. Complications of closed continuous lumbar drainage of cerebrospinal fluid. Acta Neurochir (Wien). 2002; 144:475–480. PMID: 12111503.

2. Al-Tamimi YZ, Helmy A, Bavetta S, Price SJ. Assessment of zero drift in the Codman intracranial pressure monitor: a study from 2 neurointensive care units. Neurosurgery. 2009; 64:94–98. discussion 98-99PMID: 19145157.

3. Alali AS, Gomez D, Sathya C, Burd RS, Mainprize TG, Moulton R, et al. Intracranial pressure monitoring among children with severe traumatic brain injury. J Neurosurg Pediatr. 2015; 1–10. PMID: 26273741.

4. Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R. The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg. 1977; 47:491–502. PMID: 903803.

5. Bowers SA, Marshall LF. Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis. Neurosurgery. 1980; 6:237–242. PMID: 7383286.

6. Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain injury. VII. Intracranial pressure monitoring technology. J Neurotrauma. 2007; 24(Suppl 1):S45–S54. PMID: 17511545.

7. Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma. 2007; 24(Suppl 1):S55–S58. PMID: 17511546.

8. Brazinova A, Mauritz W, Leitgeb J, Wilbacher I, Majdan M, Janciak I, et al. Outcomes of patients with severe traumatic brain injury who have Glasgow Coma Scale scores of 3 or 4 and are over 65 years old. J Neurotrauma. 2010; 27:1549–1555. PMID: 20597653.

9. Cremer OL, van Dijk GW, van Wensen E, Brekelmans GJ, Moons KG, Leenen LP, et al. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med. 2005; 33:2207–2213. PMID: 16215372.

10. Dang Q, Simon J, Catino J, Puente I, Habib F, Zucker L, et al. More fateful than fruitful? Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes. J Surg Res. 2015; 198:482–488. PMID: 25972315.

11. Dawes AJ, Sacks GD, Cryer HG, Gruen JP, Preston C, Gorospe D, et al. Intracranial pressure monitoring and inpatient mortality in severe traumatic brain injury: a propensity score-matched analysis. J Trauma Acute Care Surg. 2015; 78:492–501. discussion 501-502PMID: 25710418.

12. Exo J, Kochanek PM, Adelson PD, Greene S, Clark RS, Bayir H, et al. Intracranial pressure-monitoring systems in children with traumatic brain injury: combining therapeutic and diagnostic tools. Pediatr Crit Care Med. 2011; 12:560–565. PMID: 20625341.

13. Fakhry SM, Trask AL, Waller MA, Watts DD. IRTC Neurotrauma Task Force. Management of brain-injured patients by an evidencebased medicine protocol improves outcomes and decreases hospital charges. J Trauma. 2004; 56:492–499. discussion 499-500PMID: 15128118.

14. Fernandes HM, Bingham K, Chambers IR, Mendelow AD. Clinical evaluation of the Codman microsensor intracranial pressure monitoring system. Acta Neurochir Suppl. 1998; 71:44–46. PMID: 9779140.

15. Gelabert-González M, Ginesta-Galan V, Sernamito-García R, Allut AG, Bandin-Diéguez J, Rumbo RM. The Camino intracranial pressure device in clinical practice. Assessment in a 1000 cases. Acta Neurochir (Wien). 2006; 148:435–441. PMID: 16374566.

16. Haddad SH, Arabi YM. Critical care management of severe traumatic brain injury in adults. Scand J Trauma Resusc Emerg Med. 2012; 20:12. PMID: 22304785.

17. Kasotakis G, Michailidou M, Bramos A, Chang Y, Velmahos G, Alam H, et al. Intraparenchymal vs extracranial ventricular drain intracranial pressure monitors in traumatic brain injury: less is more? J Am Coll Surg. 2012; 214:950–957. PMID: 22541986.

18. Lee CS, Lim YC, Kim SH, Cho JM. Comparison of ventricular type and parenchymal type intracranial pressure (ICP) monitoring for the severe traumatic brain injury patients. Korean J Neurotrauma. 2012; 8:128–133.

19. Leopardi M, Tshomba Y, Kahlberg A, Baccellieri D, Melissano G, Chiesa R. Automated lumbar drainage for the control of the cerebrospinal fluid pressure during surgery for thoracoabdominal aortic aneurysms. Ann Vasc Surg. 2015; 29:1050.

20. Li LM, Timofeev I, Czosnyka M, Hutchinson PJ. Review article: the surgical approach to the management of increased intracranial pressure after traumatic brain injury. Anesth Analg. 2010; 111:736–748. PMID: 20686006.

21. Linsler S, Schmidtke M, Steudel WI, Kiefer M, Oertel J. Automated intracranial pressure-controlled cerebrospinal fluid external drainage with LiquoGuard. Acta Neurochir (Wien). 2013; 155:1589–1594. discussion 1594-1595PMID: 23188469.

22. Martínez-Mañas RM, Santamarta D, de Campos JM, Ferrer E. Camino intracranial pressure monitor: prospective study of accuracy and complications. J Neurol Neurosurg Psychiatry. 2000; 69:82–86. PMID: 10864608.

23. Miller JD, Butterworth JF, Gudeman SK, Faulkner JE, Choi SC, Selhorst JB, et al. Further experience in the management of severe head injury. J Neurosurg. 1981; 54:289–299. PMID: 7463128.

24. Miller MT, Pasquale M, Kurek S, White J, Martin P, Bannon K, et al. Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma. 2004; 56:967–972. discussion 972-973PMID: 15179234.

25. Münch E, Weigel R, Schmiedek P, Schürer L. The Camino intracranial pressure device in clinical practice: reliability, handling characteristics and complications. Acta Neurochir (Wien). 1998; 140:1113–1119. discussion 1119-1120PMID: 9870055.

26. Piper I, Barnes A, Smith D, Dunn L. The Camino intracranial pressure sensor: is it optimal technology? An internal audit with a review of current intracranial pressure monitoring technologies. Neurosurgery. 2001; 49:1158–1164. discussion 1164-1165PMID: 11846910.

27. Poca MA, Sahuquillo J, Arribas M, Báguena M, Amorós S, Rubio E. Fiberoptic intraparenchymal brain pressure monitoring with the Camino V420 monitor: reflections on our experience in 163 severely head-injured patients. J Neurotrauma. 2002; 19:439–448. PMID: 11990350.

28. Raboel PH, Bartek J Jr, Andresen M, Bellander BM, Romner B. Intracranial pressure monitoring: invasive versus non-invasive methods-a review. Crit Care Res Pract. 2012; 2012:950393. PMID: 22720148.

29. Riambau V, Capoccia L, Mestres G, Matute P. Spinal cord protection and related complications in endovascular management of B dissection: LSA revascularization and CSF drainage. Ann Cardiothorac Surg. 2014; 3:336–338. PMID: 24967177.

30. Shafi S, Diaz-Arrastia R, Madden C, Gentilello L. Intracranial pressure monitoring in brain-injured patients is associated with worsening of survival. J Trauma. 2008; 64:335–340. PMID: 18301195.

31. Staykov D, Speck V, Volbers B, Wagner I, Saake M, Doerfler A, et al. Early recognition of lumbar overdrainage by lumboventricular pressure gradient. Neurosurgery. 2011; 68:1187–1191. discussion 1191PMID: 21273925.

32. Talving P, Karamanos E, Teixeira PG, Skiada D, Lam L, Belzberg H, et al. Intracranial pressure monitoring in severe head injury: compliance with Brain Trauma Foundation guidelines and effect on outcomes: a prospective study. J Neurosurg. 2013; 119:1248–1254. PMID: 23971954.

33. Vender J, Waller J, Dhandapani K, McDonnell D. An evaluation and comparison of intraventricular, intraparenchymal, and fluidcoupled techniques for intracranial pressure monitoring in patients with severe traumatic brain injury. J Clin Monit Comput. 2011; 25:231–236. PMID: 21938526.