gms | German Medical Science

Objective: Some symptoms of intracranial pressure imbalance are difficult to observe in an inpatient-setting. For these cases monitoring of ICP at home or in an every-day setting is desirable. Combining the telemetric ICP measure probe with the possibility to safely access the readings via a computer to computer connection over the internet offers a way to overcome these challenges and provide supervision of the patient.

Method: From January 2010 to December 2014 a total of 76 patients underwent telemetric ICP monitoring at home. The main limiting factor of the home monitoring was the data storage. Patients had to come frequently to the hospital for data transfer and analysis. To optimize home monitoring we developed a new method for online data transfer to the treating team. Since February 2014 eight patients (median age 34 years, range 19 to 53 years; f:m ratio 5:3) with complex hydrocephalic symptoms received a telemetric ICP probe. Within a short in-patient setting for ICP monitoring they were trained in setting up the measuring and connection of the data logger to a laptop computer equipped with a software for safe internet connection. The patients were then discharged from hospital provided with a hotline/mobile phone number to a neurosurgeon familiar with their case. ICP monitoring was then continued as home-monitoring. In a diary special events and occurrence of headaches were documented by the patients.

Results: In all patients uncomplicated measurements could be performed and monitored via internet access from the hospital main computer or smart phone. An average of 215 hours of measuring time (range from 78 to 386 hours) was monitored. The median distance of the patients home to the hospital was 182 km (ranging from 21 to 624 km). In all cases the data were continously analysed over the distance. Diagnosis could be established and led to further treatment decisions. Home monitoring over a long period was very helpful to figure out the best shunt valve setting in 6 cases or to observe success of endoscopic third ventriculostomy in 2 cases.

Conclusions: For the first time telemetric ICP home monitoring can be performed in an outpatient setting with supervision over the internet and mobile phone. The setting of the home monitoring is very easy and effective.