Application of the proposed flowchart for assessing intracranial compliance with a non-invasive b4c sensor in the management of critical patients

Volume variations that result in increases in intracranial pressure (ICP) are directly associated with a reduction in intracranial compliance (ICC) and its non-invasive monitoring allows changes to be identified early. Objectives: To evaluate the application of an ICC assessment flowchart in a patient with traumatic brain injury (TBI). Methods: This is a case report of the application of the ICC assessment flowchart to a patient with TBI. Results: 40-year-old male patient with TBI, subarachnoid hematoma. The first monitoring showed a curve with an altered ICC, a P2/P1 ratio of 1.2, suggesting a reduction in the ICC, with the presence of Lundberg B waves, and the administration of rocuronium bromide started. After 24 hours, it presented a P2/P1 ratio of 0.88, suggesting adequate ICC, the medical team opted to reduce norepinephrine and sedation. On the following day, the patient was agitated, saturating 86%, blood pressure 113 x 60 mmHg, and a P2/P1 ratio of 1.08, suggesting a reduction in ICC. The clinical team deepened the sedation, resulting in decrease a P2/P1 ratio to 0.73, suggesting a possible risk to low cerebral blood flow, resulting in a new adjustment of sedation and ventilatory parameters, evolving with hemodynamic improvement and a P2/P1 ratio of 0.82, suggesting adequate ICC. Conclusions: The flowchart guided the medical team to use the information of ICP curve by the non-invasive sensor, supporting clinical decision making and improving the quality of the patient care and safety.