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Analysis of the ICP pulse-pressure relationship as a function of arterial blood pressure clinical validation of a mathematical model

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Summary

The influence of arterial blood pressure (ABP) on the intracranial pulse pressure relationship (PPR) was studied in 17 patients in 29 recordings, with a total period of registration of 71.5 hours. The relationship between ICP and ABP was analysed by sampling the data every 15 seconds during spontaneous fluctuations of both these variables, and the analysis was performed on the basis of a mathematical model which includes pulsatory components. MABP and ABP amplitude had an opposite effect on the slope of PPR. Flattening of the PPR slope was caused by a MABP increase or an ABP amplitude decrease. The slope became steeper with decreasing MABP or increasing ABP amplitude. In accordance with the theoretical assumptions the quotient MABP/ABP-AMP was found to be suitable to express these opposite effects on PPR. Qualitatively, the same pattern of reaction was found in all patients. Rapid changes in PPR occurring during monitoring can be explained by a change in MABP/ABP-AMP relationship, regardless whether ABP changes influence intracranial elastance or not. The breakpoint of the PPR was recorded only on two occasions and could be explained in one by the influence of ABP. Monitoring of PPR as a measure of intracranial elastance and correlation of PPR with the patient's condition it not permitted unless at least the influence of ABP is analysed in each individual case.

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Abbreviations

ABP:

Arterial blood pressure

ABP-AMP:

Arterial blood pressure amplitude

ca :

Elastance coefficient of intracranial arterial vessels

CSF:

Cerebrospinal fluid

Cv :

Compliance of the venous part of the vascular bed

CVP:

Central venous pressure

E′art :

Volume elasticity of intracranial arterial vessels

HR:

Heart rate

ICP:

Intracranial pressure

ICP-AMP:

Intracranial pressure amplitude

Ka :

Absorption rate of cerebrospinal fluid

Ks :

Secretion rate of cerebrospinal fluid

Kv :

Intracranial pressure volume curve determining parameter

MABP:

Mean arterial pressure

MICP:

Mean intracranial pressure

Part :

Systemic arterial blood pressure

Pcsf :

Cerebrospinal fluid pressure

Pven :

Systemic venous pressure

¯P ...:

Mean pressure

Δ P:

Pressure amplitude or change in pressure

PPR:

Intracranial pulse pressure relationship

PVI:

Pressure volume index

RR:

Respiration rate

Δ V:

Injected volume during a volume pressure test or the transient intracranial volume increase per cardiac cycle

VPR:

Volume pressure response

VPT:

Volume pressure test

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Author notes

  1. O. Hoffmann

    Present address: Department of Neurosurgery, University of Giessen, Germany

Authors and Affiliations

  1. Department of Neurosurgery, University of Giessen, Germany

    J. T. Zierski

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  1. O. Hoffmann
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Hoffmann, O., Zierski, J.T. Analysis of the ICP pulse-pressure relationship as a function of arterial blood pressure clinical validation of a mathematical model. Acta neurochir 66, 1–21 (1982). https://doi.org/10.1007/BF01809300

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