Fiberoptic intraparenchymal brain pressure monitoring with the Camino V420 monitor: reflections on our experience in 163 severely head-injured patients.
To assess the safety and accuracy of the Camino intraparenchymal sensor, we prospectively evaluated hemorrhagic complications, zero-drift, infection, and system malfunction in 163 patients monitored after a severe head injury. Mean duration of intracranial pressure (ICP) monitoring was 5 +/- 2.2 days (range: 12 h to 11 days). Of the 141 patients with a control CT scan, four showed a 1-2-cc collection of blood at the catheter's end. When removed, the sensors underread the true ICP value (negative zero-drift) in 80 of the 126 sensors evaluated (63.5%). Fourteen sensors showed no zero-drift, and 32 sensors overread the true ICP value (positive zero-drift) (median: -1 mm Hg; interquartile range: -4 to +1 mm Hg). No significant relationship was found between zero-drift, the surgeon who implanted the sensor, intracranial hypertension, or duration of ICP monitoring. No clinical infections could be attributed to the devices. Sixteen patients (9.8%) required more than one ICP sensor due to malfunctioning of the system. In conclusion, continuous ICP monitoring using the Camino intraparenchymal sensor has a low complication rate. However, this sensor may underread the real ICP values in a high number of patients. The lack of correlation between duration of ICP monitoring and zero-drift suggests that, contrary to the recommendations of other reports, the intraparenchymatous Camino sensor can provide reliable readings after the fifth day of use.
Poca
Maria-Antonia
MA
Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain. pocama@wanadoo.es
Sahuquillo
Juan
J
Arribas
Mercedes
M
Báguena
Marcelino
M
Amorós
Sonia
S
Rubio
Enrique
E
D001407:Bacillus / Q000302:isolation & purification; D001778:Blood Coagulation Disorders / Q000150:complications; D003352:Corynebacterium / Q000302:isolation & purification; D006259:Craniocerebral Trauma / Q000150:complications / Q000382:microbiology / Q000503:physiopathology*; D019719:Diagnostic Equipment / Q000382:microbiology; D004868:Equipment Failure; D004926:Escherichia coli / Q000302:isolation & purification; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D007427:Intracranial Pressure / Q000502:physiology*; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000295:instrumentation*; D013203:Staphylococcal Infections / Q000209:etiology / Q000503:physiopathology; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification