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oai:recercat.cat:11351/136672025-10-24T10:33:16Zcom_2072_378070com_2072_378040col_2072_378092

From indication to initiation of invasive intracranial pressure monitoring time differences between neurosurgeons and intensive care physicians: can intracranial hypertension dose be reduced? TIMING-ICP, a multicenter, observational, prospective study Mariani, Lara Calza, Stefano Gritti, Paolo Zerbi, Simone Maria Russo, Emanuele DEANA, CRISTIAN Biroli, Antonio Institut Català de la Salut [Mariani L] Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. Residency School in Anesthesiology and Intensive Care Medicine, University of Brescia, Brescia, Italy. [Calza S] Unit of Biostatistics, Epidemiology and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. [Gritti P] Department of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy. [Zerbi SM] Neurocritical Care Unit, Department of Emergency Medicine, ASST Lariana Sant’Anna Como Hospital, San Fermo Della Battaglia, Italy. [Russo E] Department of Anesthesia and Critical Care Medicine, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy. [Deana C] Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care 1, Health Integrated Agency of Central Friuli, Udine, Italy. [Biroli A] Servei de Neurocirurgia, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Unitats de cures intensives Metges Neurocirurgians Pressió intracranial Monitoratge de pacients Hipertensió intracranial NAMED GROUPS::Persons::Occupational Groups::Health Personnel::Physicians::Surgeons::Neurosurgeons NAMED GROUPS::Persons::Occupational Groups::Health Personnel::Physicians ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Monitoring, Physiologic DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Intracranial Hypertension PHENOMENA AND PROCESSES::Musculoskeletal and Neural Physiological Phenomena::Nervous System Physiological Phenomena::Cerebrospinal Fluid Pressure::Intracranial Pressure HEALTH CARE::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units DENOMINACIONES DE GRUPOS::personas::grupos profesionales::personal sanitario::médicos::cirujanos::neurocirujanos DENOMINACIONES DE GRUPOS::personas::grupos profesionales::personal sanitario::médicos TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::monitorización fisiológica ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::hipertensión intracraneal FENÓMENOS Y PROCESOS::fenómenos fisiológicos nerviosos y musculoesqueléticos::fenómenos fisiológicos del sistema nervioso::presión del líquido cefalorraquídeo::presión intracraneal ATENCIÓN DE SALUD::instalaciones, servicios y personal de asistencia sanitaria::centros sanitarios::unidades hospitalarias::unidades de cuidados intensivos Intensive care physicians; Intracranial hypertension; Neurosurgeons Médicos de cuidados intensivos; Hipertensión intracraneal; Neurocirujanos Metges de cures intensives; Hipertensió intracranial; Neurocirurgians Background The duration of episodes of intracranial hypertension is related to poor outcome, hence the need for prompt diagnosis. Numerous issues can lead to delays in the implementation of invasive intracranial pressure (ICP) monitoring, thereby increasing the dose of intracranial hypertension to which the patient is exposed. The aim of this prospective, observational, multicenter study was to assess the magnitude of this delay, evaluating the time required for initiation of invasive ICP monitoring, from indication (T1) to initiation of the maneuver (T2) when performed by neurosurgeons compared to intensive care physicians. Methods We evaluated the impact of the operator performing the maneuver (neurosurgeon vs. intensivist) on the T2-T1 time interval, where T1 represents the time at which indication for invasive ICP monitoring is declared, and T2 the time at which the maneuver starts, defined as the skin incision. The effect of the operator performing the maneuver was evaluated through a parametric survival model. Both intraparenchymal catheters (IPCs) and external ventricular drains (EVDs) were considered as invasive ICP monitoring devices. Invasive monitoring could be performed in intensive care unit (ICU) or in operating room (OR). Results A total of 112 patients were included into the final analysis; 39 IPCs were placed by intensivists within the ICU, and a total of 73 IPCs and EVDs by neurosurgeons both within the ICU and OR settings. The mean difference in T2-T1 time for IPCs placement in the ICU was 69 min (CI 50.1–94.8) in the intensivist group and 145 min (CI 103.4–202.9) in neurosurgeon group. The mean difference between these groups, 76 min, was found to be statistically significant (p-value = 0.0021). In the group treated by neurosurgeons, no statistically significant differences were found in timing between the ICU and the OR. Conclusions Invasive ICP monitoring performed with IPCs in ICU begins earlier when performed by intensivists rather than neurosurgeons. This finding suggests the possibility to obtain a prompt diagnosis of intracranial hypertension when intensivists intervein directly at patient’s bedside. Further studies are needed to confirm these findings and investigate their effect on outcome. 2025-09-16T12:06:04Z 2025-09-16T12:06:04Z 2025-06-13 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Mariani L, Calza S, Gritti P, Zerbi SM, Russo E, Deana C, et al. From indication to initiation of invasive intracranial pressure monitoring time differences between neurosurgeons and intensive care physicians: can intracranial hypertension dose be reduced? TIMING-ICP, a multicenter, observational, prospective study. Crit Care. 2025 Jun 13;29:237. 1466-609X http://hdl.handle.net/11351/13667 10.1186/s13054-025-05384-w 40506776 001507144800001 http://hdl.handle.net/11351/13667 eng Critical Care;29 https://doi.org/10.1186/s13054-025-05384-w Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess application/pdf BMC Scientia