A research carried out with a population of 50 patients with COVID-19 in serious condition, admitted to the ICU of the Hospital das Clínicas of the University of São Paulo (USP), identified a correlation between impairments in intracranial compliance and brain hemodynamics with worsening of the disease. In an article published in the journal Brain Sciences, the results show that the monitoring of the two parameters can help to anticipate the worsening of the condition of patients with the disease.
Among the 50 patients, 30 died within a week of intubation and 5 remained intubated. The research identified that this group of 35 people had greater impairment of both intracranial compliance, the ability of the skull to regulate its internal pressure, and encephalic hemodynamics, the dynamics of blood flow in the brain compared to the group of 15 people who could leave the intubation within the period.
“In this seven-day period, patients with better results for both parameters had already progressed to extubation and spontaneous ventilation”, assesses Sérgio Brasil, postdoctoral researcher in the neurosurgery division of HC/USP and leader of the study, which had the participation of 14 other researchers. “I make the reservation that we found vascular alterations in almost all patients, but their severity was correlated with the patient’s inability to progress to spontaneous breathing. Even when we did the last evaluation, when the patient was already extubated and spontaneously ventilating , the prevalence of alterations in the exams was still high, but significantly lower than at the beginning of intubation.”
One of the premises that guided the conduct of the study was the fact that COVID-19 had many neurological symptoms, such as headaches, nausea, anosmia (loss of smell) and paresthesia (tingling sensation). In addition, severely ill patients often suffer from solitude, lethargy and delirium. Thus, the monitoring of intracranial compliance and brain hemodynamics would allow understanding changes in brain perfusion in patients and support clinical decisions that would help in their recovery.
The study followed 50 COVID-19 patients consecutively admitted to six ICUs at Hospital das Clínicas between May and June 2020. For each patient, intracranial compliance and brain hemodynamics were measured on two occasions: the first during the first 72 hours after intubation and the second also within a period of up to three days after the removal of mechanical ventilation. Brain hemodynamics were measured using transcranial Doppler, while intracranial compliance was measured using a non-invasive sensor.
“The measurements of these two parameters are complementary. They all help each other in some way and it is bad when we have few monitoring instruments, because we are more limited in the range of diagnoses that can be made”, ponders Sérgio Brasil. “When we can do serial monitoring of the patient, there is a greater chance of detecting early on when the patient’s condition starts to get worse and taking some action to prevent it from getting worse.”The article “Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study”, which presents the results of the research, published on June 30, 2021 in the journal Brain Sciences and can be accessed by DOI: 10.3390/brainsci11070874
