Advertisement

Acta Neurochirurgica

, Volume 146, Issue 2, pp 131–141 | Cite as

Intracranial hypertension: what additional information can be derived from ICP waveform after head injury?

  • M. Balestreri
  • M. Czosnyka
  • L. A. Steiner
  • E. Schmidt
  • P. Smielewski
  • B. Matta
  • J. D. Pickard
Clinical Article

Summary

Objective. Although intracranial hypertension is one of the important prognostic factors after head injury, increased intracranial pressure (ICP) may also be observed in patients with favourable outcome. We have studied whether the value of ICP monitoring can be augmented by indices describing cerebrovascular pressure-reactivity and pressure-volume compensatory reserve derived from ICP and arterial blood pressure (ABP) waveforms.

Method. 96 patients with intracranial hypertension were studied retrospectively: 57 with fatal outcome and 39 with favourable outcome. ABP and ICP waveforms were recorded. Indices of cerebrovascular reactivity (PRx) and cerebrospinal compensatory reserve (RAP) were calculated as moving correlation coefficients between slow waves of ABP and ICP, and between slow waves of ICP pulse amplitude and mean ICP, respectively. The magnitude of ‘slow waves’ was derived using ICP low-pass spectral filtration.

Results. The most significant difference was found in the magnitude of slow waves that was persistently higher in patients with a favourable outcome (p<0.00004). In patients who died ICP was significantly higher (p<0.0001) and cerebrovascular pressure-reactivity (described by PRx) was compromised (p<0.024). In the same patients, pressure-volume compensatory reserve showed a gradual deterioration over time with a sudden drop of RAP when ICP started to rise, suggesting an overlapping disruption of the vasomotor response.

Conclusion. Indices derived from ICP waveform analysis can be helpful for the interpretation of progressive intracranial hypertension in patients after brain trauma.

Keywords: Brain injury; intracranial hypertension; intracranial pressure; waveform analysis; outcome. 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Copyright information

© Springer-Verlag/Wien 2004

Authors and Affiliations

  • M. Balestreri
    • 1
  • M. Czosnyka
    • 1
  • L. A. Steiner
    • 1
    • 2
  • E. Schmidt
    • 1
  • P. Smielewski
    • 1
  • B. Matta
    • 2
  • J. D. Pickard
    • 1
  1. 1.Department of NeurosurgeryAddenbrooke’s HospitalCambridgeUK
  2. 2.Department of AnaesthesiologyAddenbrooke’s HospitalCambridgeUK

Personalised recommendations