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01-08-2012 | Original Article

Continuous Monitoring of Cerebrovascular Reactivity Using Pulse Waveform of Intracranial Pressure

Published in: Neurocritical Care | Issue 1/2012

Abstract

Background

Guidelines for the management of traumatic brain injury (TBI) call for the development of accurate methods for assessment of the relationship between cerebral perfusion pressure (CPP) and cerebral autoregulation and to determine the influence of quantitative indices of pressure autoregulation on outcome. We investigated the relationship between slow fluctuations of arterial blood pressure (ABP) and intracranial pressure (ICP) pulse amplitude (an index called PAx) using a moving correlation technique to reflect the state of cerebral vasoreactivity and compared it to the index of pressure reactivity (PRx) as a moving correlation coefficient between averaged values of ABP and ICP.

Methods

A retrospective analysis of prospective 327 TBI patients (admitted on neurocritical care unit of a university hospital in the period 2003–2009) with continuous ABP and ICP monitoring.

Results

PAx was worse in patients who died compared to those who survived (−0.04 ± 0.15 vs. −0.16 ± 0.15, χ² = 28, p < 0.001). In contrast to PRx, PAx was able to differentiate between fatal and non-fatal outcome in a group of 120 patients with ICP levels below 15 mmHg (−0.04 ± 0.16 vs. −0.14 ± 0.16, χ² = 6, p = 0.01).

Conclusions

PAx is a new modified index of cerebrovascular reactivity which performs equally well as established PRx in long-term monitoring in severe TBI patients, but importantly is potentially more robust at lower values of ICP. In view of establishing an autoregulation-oriented CPP therapy, continuous determination of PAx is feasible but its value has to be evaluated in a prospective controlled trail.

Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma. 2007;24(Suppl 1):S59–64.PubMed

Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD. Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery. 1997;41(1):11–7.PubMedCrossRef

Zweifel C, Lavinio A, Steiner LA, et al. Continuous monitoring of cerebrovascular pressure reactivity in patients with head injury. Neurosurg Focus. 2008;25(4):E2.PubMedCrossRef

Steiner LA, Czosnyka M, Piechnik SK, et al. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002;30(4):733–8.PubMedCrossRef

Rosner MJ. The vasodilatory cascade and intracranial pressure. In: Miller JD, Teasdale JM, Rowan JO, Galbraiht SL, Mendelow AD, editors. Intracranial pressure. Berlin: Springer Verlag; 1986. p. 137–41.

Bouma GJ, Muizelaar JP, Bandoh K, Marmarou A. Blood pressure and intracranial pressure-volume dynamics in severe head injury: relationship with cerebral blood flow. J Neurosurg. 1992;77(1):15–9.PubMedCrossRef

Timofeev I, Czosnyka M, Nortje J, et al. Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury. J Neurosurg. 2008;108(1):66–73.PubMedCrossRef

Avezaat CJ, van Eijndhoven JH, Wyper DJ. Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psychiatry. 1979;42(8):687–700.PubMedCrossRef

Marmarou A, Shulman K, Rosende RM. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg. 1978;48(3):332–4.PubMedCrossRef

10.

Holm S, Eide PK. The frequency domain versus time domain methods for processing of intracranial pressure (ICP) signals. Med Eng Phys. 2008;30(2):164–70.PubMedCrossRef

11.

Bentsen G, Stubhaug A, Eide PK. Differential effects of osmotherapy on static and pulsatile intracranial pressure. Crit Care Med. 2008;36(8):2414–9.PubMedCrossRef

12.

Eide PK, Sorteberg W. Intracranial pressure levels and single wave amplitudes, Glasgow Coma Score and Glasgow Outcome Score after subarachnoid haemorrhage. Acta Neurochir (Wien). 2006;148(12):1267–75.CrossRef

13.

Carrera E, Kim DJ, Castellani G, et al. What shapes pulse amplitude of intracranial pressure? J Neurotrauma. 2010;27(2):317–24.PubMedCrossRef

14.

Radolovich DK, Aries MJ, Castellani G, et al. Pulsatile intracranial pressure and cerebral autoregulation after traumatic brain injury. Neurocrit Care. 2011;15:379–86.PubMedCrossRef

15.

Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ. Specialist neurocritical care and outcome from head injury. Intensive Care Med. 2002;28(5):547–53.PubMedCrossRef

16.

Marmarou A, Lu J, Butcher I, et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. 2007;24(2):270–80.PubMedCrossRef

17.

Hutchinson PJ, Hutchinson DB, Barr RH, Burgess F, Kirkpatrick PJ, Pickard JD. A new cranial access device for cerebral monitoring. Br J Neurosurg. 2000;14(1):46–8.PubMedCrossRef

18.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.PubMedCrossRef

19.

Steiner LA, Coles JP, Johnston AJ, et al. Assessment of cerebrovascular autoregulation in head-injured patients: a validation study. Stroke. 2003;34(10):2404–9.PubMedCrossRef

20.

Czosnyka M, Guazzo E, Whitehouse M, et al. Significance of intracranial pressure waveform analysis after head injury. Acta Neurochir (Wien). 1996;138(5):531–41.CrossRef

21.

Czosnyka M, Piechnik S, Richards HK, Kirkpatrick P, Smielewski P, Pickard JD. Contribution of mathematical modelling to the interpretation of bedside tests of cerebrovascular autoregulation. J Neurol Neurosurg Psychiatry. 1997;63(6):721–31.PubMedCrossRef

22.

Mahfoud F, Beck J, Raabe A. Intracranial pressure pulse amplitude during changes in head elevation: a new parameter for determining optimum cerebral perfusion pressure? Acta Neurochir (Wien). 2010;152(3):443–50.CrossRef

23.

Piper IR, Miller JD, Dearden NM, Leggate JR, Robertson I. Systems analysis of cerebrovascular pressure transmission: an observational study in head-injured patients. J Neurosurg. 1990;73(6):871–80.PubMedCrossRef

24.

Zweifel C, Castellani G, Czosnyka M, et al. Noninvasive monitoring of cerebrovascular reactivity with near infrared spectroscopy in head-injured patients. J Neurotrauma. 2010;27(11):1951–8.PubMedCrossRef

Title: Continuous Monitoring of Cerebrovascular Reactivity Using Pulse Waveform of Intracranial Pressure
Publication date: 01-08-2012
Published in: Neurocritical Care / Issue 1/2012
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-012-9687-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Continuous Monitoring of Cerebrovascular Reactivity Using Pulse Waveform of Intracranial Pressure

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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