Skip to main content
Log in

An evaluation of three measures of intracranial compliance in traumatic brain injury patients

  • Physiological and Technical Notes
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

To compare intracranial pressure (ICP) amplitude, ICP slope, and the correlation of ICP amplitude and ICP mean (RAP index) as measures of compliance in a cohort of traumatic brain injury (TBI) patients.

Methods

Mean values of the three measures were calculated in the 2-h periods before and after surgery (craniectomies and evacuations), and in the 12-h periods preceding and following thiopental treatment, and during periods of thiopental coma. The changes in the metrics were evaluated using the Wilcoxon test. The correlations of 10-day mean values for the three metrics with age, admission Glasgow Motor Score (GMS), and Extended Glasgow Outcome Score (GOSe) were evaluated. Patients under and over 60 years old were also compared using the Student t test. The correlation of ICP amplitude with systemic pulse amplitude was analyzed.

Results

ICP amplitude was significantly correlated with GMS, and also with age for patients 35 years old and older. The correlations of ICP slope and the RAP index with GMS and with age were not significant. All three metrics indicated significant improvements in compliance following surgery and during thiopental coma. None of the metrics were significantly correlated with outcome, possibly due to confounding effects of treatment factors. The correlation of systemic pulse amplitude with ICP amplitude was low (R = 0.18), only explaining 3 % of the variance.

Conclusions

This study provides further validation for all three of these features of the ICP waveform as measures of compliance. ICP amplitude had the best performance in these tests.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Miller JD, Garibi J, Pickard JD (1973) Induced changes of cerebrospinal fluid volume. Effects during continuous monitoring of ventricular fluid pressure. Arch Neurol 28:265–269

    Article  PubMed  CAS  Google Scholar 

  2. Marmarou AK, Shulman K, LaMorgese J (1975) Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43:523–534

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  4. Robertson CS, Narayan RK, Contant CF, Grossman RG, Gokaslan ZL, Pahwa R, Caram P, Bray RS, Sherwood AM (1989) Clinical experience with a continuous monitor of intracranial compliance. J Neurosurg 71:673–680

    Article  PubMed  CAS  Google Scholar 

  5. Piper IR, Spiegelberg A, Whittle I, Signorini D, Mascia L (1999) A comparative study of the Spiegelberg compliance device with a manual volume-injection method: a clinical evaluation in patients with hydrocephalus. Br J Neurosurg 13:581–586

    Article  PubMed  CAS  Google Scholar 

  6. Piper IR, Miller JD, Whittle IR, Lawson A (1990) Automated time-averaged analysis of craniospinal compliance (short pulse response). Acta Neurochir Suppl (Wien) 51:387–390

    CAS  Google Scholar 

  7. Abdullah J, Zamzuri I, Awang S, Sayuthi S, Ghani A, Tahir A, Naing NN (2005) Preliminary report on Spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy. Acta Neurochir Suppl 95:311–314

    Article  PubMed  CAS  Google Scholar 

  8. Kiening KL, Schoening W, Unterberg AW, Stover JF, Citerio G, Enblad P, Nilsson P (2005) Assessment of the relationship between age and continuous intracranial compliance. Acta Neurochir Suppl 95:293–297

    Article  PubMed  CAS  Google Scholar 

  9. Salci K, Nilsson P, Howells T, Ronne-Engström E, Piper I, Contant CF, Enblad P (2006) Intracerebral microdialysis and intracranial compliance monitoring of patients with traumatic brain injury. J Clin Monit Comput 20:25–31

    Article  PubMed  Google Scholar 

  10. Yau Y, Piper I, Contant C, Citerio G, Kiening K, Enblad P, Nilsson P, Ng S, Wasserberg J, Kiefer M, Poon W, Dunn L, Whittle I (2002) Multi-centre assessment of the Spiegelberg compliance monitor: interim results. Acta Neurochir Suppl 81:167–170

    PubMed  CAS  Google Scholar 

  11. Kiening KL, Schoening WN, Lanksch WR, Unterberg AW (2002) Intracranial compliance as a bed-side monitoring technique in severely head-injured patients. Acta Neurochir Suppl 81:177–180

    PubMed  CAS  Google Scholar 

  12. Wilkinson HA, Schuman N, Ruggiero J (1979) Nonvolumetric methods of detecting impaired intracranial compliance or reactivity: pulse width and wave form analysis. J Neurosurg 50:758–767

    Article  PubMed  CAS  Google Scholar 

  13. Castellani G, Zweifel C, Kim DJ, Carrera E, Radolovich DK, Smielewski P, Hutchinson PJ, Pickard JD, Czosnyka M (2009) Plateau waves in head injured patients requiring neurocritical care. Neurocrit Care 11:143–150

    Article  PubMed  Google Scholar 

  14. Czosnyka M, Czosnyka ZH, Whitfield PC, Donovan T, Pickard JD (2001) Age dependence of cerebrospinal pressure–volume compensation in patients with hydrocephalus. J Neurosurg 94:482–486

    Article  PubMed  CAS  Google Scholar 

  15. Kim DJ, Czosnyka Z, Keong N, Radolovich DK, Smielewski P, Sutcliffe MP, Pickard JD, Czosnyka M (2009) Index of cerebrospinal compensatory reserve in hydrocephalus. Neurosurgery 64:494–501 (discussion 501-2)

    Google Scholar 

  16. Timofeev I, Czosnyka M, Nortje J, Smielewski P, Kirkpatrick P, Gupta A, Hutchinson P (2008) Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury. J Neurosurg 108:66–73

    Article  PubMed  Google Scholar 

  17. Timofeev I, Dahyot-Fizelier C, Keong N, Nortje J, Al-Rawi PG, Czosnyka M, Menon DK, Kirkpatrick PJ, Gupta AK, Hutchinson PJ (2008) Ventriculostomy for control of raised ICP in acute traumatic brain injury. Acta Neurochir Suppl 102:99–104

    Article  PubMed  CAS  Google Scholar 

  18. Eide PK, Bentsen G, Sorteberg AG, Marthinsen PB, Stubhaug A, Sorteberg W (2011) A randomized and blinded single-center trial comparing the effect of intracranial pressure (ICP) versus ICP wave amplitude guided intensive care management on early clinical state and 12 months outcome in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 69:1105–1115

    PubMed  Google Scholar 

  19. Bentsen G, Stubhaug A, Eide PK (2008) Differential effects of osmotherapy on static and pulsatile intracranial pressure. Crit Care Med 36:2414–2419

    Article  PubMed  Google Scholar 

  20. Eide PK, Rapoport BI, Gormley WB, Madsen JR (2010) A dynamic nonlinear relationship between the static and pulsatile components of intracranial pressure in patients with subarachnoid hemorrhage. J Neurosurg 112:616–625

    Article  PubMed  Google Scholar 

  21. Eide PK, Sorteberg W (2007) Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds. Neurol Res 29:798–802

    Article  PubMed  CAS  Google Scholar 

  22. Contant CF Jr, Robertson CS, Crouch J, Gopinath SP, Narayan RK, Grossman RG (1995) Intracranial pressure waveform indices in transient and refractory intracranial hypertension. J Neurosci Methods 57:15–25

    Article  PubMed  Google Scholar 

  23. Hu X, Xu P, Asgari S, Vespa P, Bergsneider M (2010) Forecasting ICP elevation based on prescient changes of intracranial pressure waveform morphology. IEEE Trans Biomed Eng 57:1070–1078

    Article  PubMed  Google Scholar 

  24. Asgari S, Bergsneider M, Hamilton R, Vespa P, Hu X (2011) Consistent changes in intracranial pressure waveform morphology induced by acute hypercapnic cerebral vasodilatation. Neurocrit Care 15:55–62

    Article  PubMed  Google Scholar 

  25. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84

    Article  CAS  Google Scholar 

  26. Wilson JT, Pettigrew LE, Teasdale GM (1998) Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma 15:573–585

    Article  PubMed  CAS  Google Scholar 

  27. Elf K, Nilsson P, Enblad P (2002) Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care. Crit Care Med 30:2129–2134

    Article  PubMed  Google Scholar 

  28. Howells T, Elf K, Jones PA, Ronne-Engström E, Piper I, Nilsson P, Andrews PJA, Enblad P (2005) Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg 102:311–317

    Article  PubMed  Google Scholar 

  29. Engelse WAH, Zeelenberg C (1979) A single scan algorithm for QRS detection and feature extraction. IEEE Comp in Card 6:37–42

    Google Scholar 

  30. Pino E, Ohno-Machado L, Wiechmann E, Curtis D (2005) Real-time ECG algorithms for ambulatory patient monitoring. AMIA Annu Symp Proc 2005:604–608

    Google Scholar 

  31. Goldberger AL, Amaral LA, Glass L, Hausdorff JM, Ivanov PC, Mark RG, Mietus JE, Moody GB, Peng CK, Stanley HE (2000) PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation 101:E215–E220

    PubMed  CAS  Google Scholar 

  32. Hoare SW, Beatty PC (2000) Automatic artifact identification in anaesthesia patient record keeping: a comparison of techniques. Med Eng Phys 22:547–553

    Article  PubMed  CAS  Google Scholar 

  33. Jakob S, Korhonen I, Ruokonen E, Virtanen T, Kogan A, Takala J (2000) Detection of artifacts in monitored trends in intensive care. Comput Methods Programs Biomed 63:203–209

    Article  PubMed  CAS  Google Scholar 

  34. Mäkivirta A, Koski E, Kari A, Sukuvaara T (1991) The median filter as a preprocessor for a patient monitor limit alarm system in intensive care. Comput Methods Programs Biomed 34:139–144

    Article  PubMed  Google Scholar 

  35. Chestnut DE, Ghajar J, Maas AIR, Marion DW, Servadei F, Teasdale GM, Unterberg A, von Holst H, Walters BC (2000) Early Indicators if prognosis in severe traumatic brain injury—age. J Neurotrauma 17:573–581

    Article  Google Scholar 

  36. Pierce EC, Lambertsen CJ, Deutsch S, Chase PE, Linde HW, Dripps RD, Price HL (1962) Cerebral circulation and metabolism during thiopental anesthesia and hyper-ventilation in man. J Clin Invest 41:1664–1671

    Article  PubMed  CAS  Google Scholar 

  37. Cormio M, Gopinath SP, Valadka A, Robertson CS (1999) Cerebral hemodynamic effects of pentobarbital coma in head-injured patients. J Neurotrauma 16:927–936

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tim Howells.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-012-2572-6.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Howells, T., Lewén, A., Sköld, M.K. et al. An evaluation of three measures of intracranial compliance in traumatic brain injury patients. Intensive Care Med 38, 1061–1068 (2012). https://doi.org/10.1007/s00134-012-2571-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-012-2571-7

Keywords

Navigation