Neurocritical care waveform recordings in pediatric patients

Abstract

This database contains de-identified, time-locked waveform recordings from pediatric patients in neurocritical care. Typical waveforms collected at the bedside include arterial blood pressure, intracranial pressure, and cerebral blood flow velocity. Additionally, information include the hematocrit and the vertical location (i.e. height) of the blood pressure transducer and intracranial pressure transducer to account for potential hydrostatic pressure differences between the two pressure measurements. In total, the initial release contains data from 12 patients with a variety of pathologies necessitating invasive intracranial pressure monitoring. The total recording duration is about 10 hours across all patients and studies.

Background

Invasive intracranial pressure (ICP) monitoring is used to direct medical interventions that target the development and consequences of elevated intracranial pressure (ICP) related to severe traumatic brain injury (TBI) and other etiologies such as late sequelae of craniosynostosis, metabolic disorders, and selected causes of encephalopathy.

In support of the development and validation of a fully automated modeling and signal processing approach to estimate ICP that has applicability in neurosurgical practice, we collected transcranial Doppler (TCD) ultrasound measurements of the middle cerebral artery (MCA) cerebral blood flow velocity (CBFV) and invasive radial arterial blood pressure (ABP). CBFV measurements are routinely performed in most tertiary pediatric hospitals that typically care for children with neurological diseases who might require ICP monitoring.

Methods

Data collection occurred up to twice daily during dedicated bedside recording sessions for the duration that invasive intracranial pressure (ICP) and arterial blood pressure (ABP) monitoring were indicated for clinical management. Both waveforms were recorded by Philips MP-90 bedside monitors (Philips Healthcare, Andover, MA). The ICP transducers were referenced to the level of the tragus while the ABP transducers were typically referenced to the level of the heart. Right and left middle cerebral artery (MCA) blood flow velocity (CBFV) waveform recordings were performed using the Spencer ST³ TCD ultrasound system (Spencer Technologies, Seattle, WA) and conducted by members of the study team experienced and credentialed in TCD ultrasonography or having undergone proctored hands-on TCD training sessions. The simultaneously acquired ABP, ICP, and CBFV waveforms were streamed digitally, nominally at 125 samples/s, to a Moberg Component Neuromonitoring System (Moberg Research, Ambler, PA) for archiving. During each data-acquisition session, the patient’s most recent hematocrit value was recorded. Additionally, we performed bedside measurements of the vertical height of the pressure transducers to account, post hoc, for potential differences in hydrostatic pressures due to differences in transducer locations. All data are de-identified.

Data Description

The dataset comprises data from 12 pediatric and young adult patients (aged 2-25 years) who underwent invasive intracranial pressure monitoring. In total, the dataset encompasses approximately 10 hours of recorded data. Each data record contains arterial blood pressure (units: mmHg), intracranial pressure (units: mmHg), cerebral blood flow velocity (units: cm/s) of the right middle cerebral artery (RMCA) or left middle cerebral artery (LMCA), hematocrit (units: %), vertical height of arterial blood pressure transducer (units: cm), and vertical height of intracranial pressure transducer (units: cm). Each data record contains about 60 or more beats of data that passed a sequence of steps to assess the signal quality of the arterial blood pressure and cerebral blood flow velocity waveforms.

The data is formatted in PhysioNet WFDB format and is organized within the waves folder. Recordings from different study sessions (see [1]) for each patient are stored in separate WFDB records. Records are named based on the patient number, the associated study session, and the location where cerebral blood flow velocity was measured (either LMCA or RMCA). Each data record contains the following:

• ABP arterial blood pressure (units: mmHg).
• ICP intracranial pressure (units: mmHg).
• CBFV cerebral blood flow velocity (units: cm/s) of the right middle cerebral artery (RMCA) or left middle cerebral artery (LMCA).
• hAbp vertical height of arterial blood pressure transducer (units: cm).
• hIcp vertical height of intracranial pressure transducer (units: cm).
• Hct hematocrit (units: %).

ABP, ICP, and CBFV are sampled at 125 Hz.

Usage Notes

The ICP, ABP, and CBFV waveforms have been time-aligned post-hoc. People interested in using the data should refer to Fanelli et al. [1] for details on the time-alignment procedure. Researchers interested in how the data have been used may consult [1-3].

Release Notes

The current release contains data described in [1]. Authors are asked to cite [1] should they make use of the data in their own work.

Ethics

The study protocol was approved by the relevant Institutional Review Boards. Written informed consent and assent (when appropriate) were obtained from the patient or their legally authorized representatives.

Acknowledgements

This study was supported, in part, by the National Institute of Neurological Disorders and Stroke (Grant R21 NS084264); Maxim Integrated Products; and from a Neurocritical Care Chair Award from the Department of Anesthesiology, Critical Care, and Pain Medicine at Boston Children’s Hospital.

Conflicts of Interest

None.

References

1. Fanelli A, Vonberg F, LaRovere K, Walsh B, Smith E, Robinson S, Tasker RC, Heldt T. (2019). Fully automated, real-time, calibration-free, continuous noninvasive estimation of intracranial pressure in children. Journal of Neurosurgery: Pediatrics 24(5): 509-519. https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/24/5/article-p509.xml
2. Imaduddin SM, Fanelli A, Vonberg FW, Tasker RC, Heldt T. (2020). Pseudo-Bayesian model-based noninvasive intracranial pressure estimation and tracking, IEEE Transactions on Biomedical Engineering 67(6): 1604-1615. https://ieeexplore.ieee.org/document/8836658
3. Jaishankar R, Fanelli A, Filippidis A, Vu T, Holsapple J, Heldt T. (2020). A spectral approach to noninvasive intracranial pressure estimation, IEEE Journal of Biomedical and Health Informatics 24(8): 2398-2406. https://ieeexplore.ieee.org/document/8836658