Safety profile of an intracranial multimodal monitoring bolt system for neurocritical care: a single-center experience

Acta Neurochir (Wien). 2021 Dec;163(12):3259-3266. doi: 10.1007/s00701-021-04992-z. Epub 2021 Sep 8.

Abstract

Background: Intracranial multimodality monitoring (iMMM) is increasingly used in acute brain-injured patients; however, safety and reliability remain major concerns to its routine implementation.

Methods: We performed a retrospective study including all patients undergoing iMMM at a single European center between July 2016 and January 2020. Brain tissue oxygenation probe (PbtO2), alone or in combination with a microdialysis catheter and/or an 8-contact depth EEG electrode, was inserted using a triple-lumen bolt system and targeting normal-appearing at-risk brain area on the injured side, whenever possible. Surgical complications, adverse events, and technical malfunctions, directly associated with iMMM, were collected. A blinded imaging review was performed by an independent radiologist.

Results: One hundred thirteen patients with 123 iMMM insertions were included for a median monitoring time of 9 [3-14] days. Of those, 93 (76%) patients had only PbtO2 probe insertion and 30 (24%) had also microdialysis and/or iEEG monitoring. SAH was the most frequent indication for iMMM (n = 60, 53%). At least one complication was observed in 67/123 (54%) iMMM placement, corresponding to 58/113 (51%) patients. Misplacement was observed in 16/123 (13%), resulting in a total of 6/16 (38%) malfunctioning PbtO2 catheters. Intracranial hemorrhage was observed in 14 iMMM placements (11%), of which one required surgical drainage. Five placements were complicated by pneumocephalus and 4 with bone fragments; none of these requires additional surgery. No CNS infection related to iMMM was observed. Seven (6%) probes were accidentally dislodged and 2 probes (2%) were accidentally broken. Ten PbtO2 probes (8%) presented a technical malfunction after a median of 9 [ranges: 2-24] days after initiation of monitoring and 4 of them were replaced.

Conclusions: In this study, a high occurrence of complications related to iMMM was observed, although most of them did not require specific interventions and did not result in malfunctioning monitoring.

Keywords: Acute brain injury; Complications; Monitoring; PbtO2.

MeSH terms

  • Brain*
  • Humans
  • Monitoring, Physiologic
  • Oxygen*
  • Reproducibility of Results
  • Retrospective Studies

Substances

  • Oxygen