Acta Neurochirurgica

, Volume 66, Issue 1–2, pp 1–21 | Cite as

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

  • O. Hoffmann
  • J. T. Zierski
Article

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.

Keywords

Arterial blood pressure ICP monitoring ICP pulse amplitude analysis intracranial pressure mathematical model 

Definitions of Abbreviations and Symbols

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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References

  1. 1.
    Avezaat, C. J. J., van Eijndhoven, J. H. M., Wyper, D. J., Cerebrospinal fluid pressure and intracranial volume-pressure relationships. J. Neurol. Neurosurg. Psych.42 (1979), 687–700.Google Scholar
  2. 2.
    Avezaat, C. J. J., van Eijndhoven, J. H. M., Wyper, D. J., Effects of hypercapnia and arterial hypotension and hypertension on cerebrospinal fluid pulse pressure and intracranial volume-pressure relationship. J. Neurol. Neurosurg. Psych.43 (1980), 222–234.Google Scholar
  3. 3.
    Benabid, A. L., de Rougement, J., Chirossel, J. P., Barge, M., Does the pressure-volume-relationship exist? In: Intracranial pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 60–65. Berlin-Heidelberg-New York: Springer. 1980.Google Scholar
  4. 4.
    Chopp, M., Portnoy, H. D., Systems analysis of intracranial pressure. Comparison with volume-pressure test and CSF-pulse amplitude analysis. J. Neurosurg.53 (1980), 516–527.PubMedGoogle Scholar
  5. 5.
    Cutler, R. W. P., Page, L., Galicich, J., Watters, G. V., Formation and absorption of cerebrospinal fluid in man. Brain91 (1968), 707–720.PubMedGoogle Scholar
  6. 6.
    Van Eijndhoven, J. H. M., Avezaat, C. J. J., The analogy between CSF pulse pressure and volume-pressure response. In: Intracranial pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 173–176. Berlin-Heidelberg-New York: Springer. 1980.Google Scholar
  7. 7.
    Gaab, M., Die Registrierung des intrakraniellen Druckes. Thesis, Würzburg, 1980.Google Scholar
  8. 8.
    Hamer, J., Alberti, E., Hoyer, S., Wiedemann, K., Influence of systemic and cerebral vascular factors on the cerebrospinal fluid pulse waves. J. Neurosurg.46 (1977), 36–45.PubMedGoogle Scholar
  9. 9.
    Hoffmann, O., Mathematische Modelle zur Untersuchung der Liquordynamik. Giessen: Ph.D. Thesis. 1980.Google Scholar
  10. 10.
    Janny, P., La surveillance de la pression intra-cranienne en neurochirurgie. Neurochirurgie20 (1974), 521–550.PubMedGoogle Scholar
  11. 11.
    Leyden, E., Beiträge und Untersuchungen zur Physiologie und Pathologie des Gehirns, über Hirndruck und Hirnbewegungen. Virchow's Archiv37 (1886), 519–559.Google Scholar
  12. 12.
    Löfgren, J., Effects of variations in arterial pressure and arterial carbon dioxide tension on the cerebrospinal fluid pressure-volume relationship. Acta Neurol. Scand.49 (1973), 586–598.PubMedGoogle Scholar
  13. 13.
    Lorenz, R., Wirkungen intrakranieller raumfordernder Prozesse auf den Verlauf vcn Blutdruck und Pulsfrequenz. Acta neurochir. (Wien), Suppl.20. Wien-New York: Springer. 1973.Google Scholar
  14. 14.
    Marmarou, A., Shulman, K., la Morgese, J., A compartmental analysis of compliance and outflow resistance and the effects of elevated blood pressure. In: Intracranial pressure II (Lundberg, N., Pontén, U., Brock, M., eds.), pp. 86–88. Berlin-Heidelberg-New York: Springer. 1975.Google Scholar
  15. 15.
    Marmarou, A., Shulman, K., la Morgese, J., Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J. Neurosurg.43 (1975), 523–534.PubMedGoogle Scholar
  16. 16.
    Miller, J. D., Garibi, J., Pickard, J. D., Induced changes of cerebrospinal fluid volume. Arch. Neurol.28 (1973), 265–269.PubMedGoogle Scholar
  17. 17.
    Mosso, A., Über den Kreislauf des Blutes im menschlichen Gehirn. Leipzig: Veit und Comp. 1881.Google Scholar
  18. 18.
    Nornes, J., Aaslid, R., Lindegaard, K. F., Intracranial pulse pressure dynamics in patients with intracranial hypertension. Acta neurochir. (Wien)38 (1977), 177–186.Google Scholar
  19. 19.
    Nyary, J., Vajda, J., Pásztor, E., Clinical experiences with intracranial volume-pressure response. In: Intracranial pressure IV (Shulman, K., Marmarou, A., Miller, J. D., Becker, D. P., Hochwald, G. M., Brock, M., eds.), pp. 116–119. Berlin-Heidelberg-New York: Springer. 1980.Google Scholar
  20. 20.
    Ryder, H. W., Frank, F. F., Kimbell, F. D.,et al., The elasticity of the craniospinal venous bed. J. Lab. Clin. Med.42 (1953), 944.Google Scholar
  21. 21.
    Sklar, F. H., Elashvili, I., The pressure volume function of brain elasticity. J. Neurosurg.47 (1977), 670–679.PubMedGoogle Scholar
  22. 22.
    Sullivan, H. G., Miller, J. D., Griffith, R. L., Becker, D. P., CSF pressure-volume dynamics in neurosurgical patients. A preliminary evaluation in six patients. Surg. Neurol.9 (1978), 47–54.PubMedGoogle Scholar
  23. 23.
    Symon, L., Crockard, M. A., Juhasz, J., Some aspects of cerebrovascular resistance in raised intracranial pressure. An experimental study. In: Intracranial pressure II (Lundberg, N., Pontén, U., Brock, M., eds.), pp. 257–262. Berlin-Heidelberg-New York: Springer. 1975.Google Scholar
  24. 24.
    Szewczykowski, J., Śliwka, S., Kunicki, A., Dytko, P., Korsak-Śliwka, J., A fast method of estimating the elastance of the intracranial system. J. Neurosurg.47 (1977), 19–26.PubMedGoogle Scholar
  25. 25.
    Wilkinson, H. A., Schuman, N., Ruggiero, J., Nonvolumetric methods of detecting impaired intracranial compliance or reactivity. Pulse width and wave form analysis. J. Neurosurg.50 (1979), 758–767.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1982

Authors and Affiliations

  • O. Hoffmann
    • 1
  • J. T. Zierski
    • 1
  1. 1.Department of NeurosurgeryUniversity of GiessenGermany

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