Abstract
Background
The intracranial pressure (ICP) is usually continuously monitored in the management of patients with increased ICP. The aim of this study was to discover a mathematic equation to express the intracranial pressure–volume (P–V) curve and a single indicator to reflect the status of the curve.
Methods
Patients with severe brain damage who had bilateral external ventricular drainage (EVD) from December 2008 to February 2010 were included in this study. The EVD was used as drainage of CSF and ICP monitor. The successive volume pressure response [6] values were obtained by successive drainage of CSF from ICP 20–25 to 10 mmHg. Parabolic, exponential, and linear regression models were designed to have a single parameter as the indicator to determine the P–V curves.
Results
The mean of parameter “a” in the exponential equation is 1.473 ± 0.054; in the parabolic equation, it is 0.332 ± 0.061; and in the linear equation, it is 1.717 ± 0.209. All regression equations of P–V curves had statistical significance (p < 0.005). Parabolic and exponential equations are closer to the original ICP curve than linear equation (p < 0.005). There is no statistically significant difference between parabolic and exponential regressions.
Conclusions
The P–V curve can be expressed with linear, parabolic, and exponential regression models in increased ICP patients. The parabolic and exponential equations are more accurate methods to represent the P–V curve. The single parameter in the three regression equations can be compared in different conditions of one patient in clinical practice.
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Acknowledgments
The authors would like to thank Professor David J. Fairholm (Professor, Department of Neurosurgery, University of British Columbia ) for his advice and comments and Miss She-Hung Chan for her statistical assistance. The study was supported by the Chang Gung Medical Research Council (grant no. CMRPG 371581). No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or any organization with which the authors are associated.
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Comments
This is an interesting paper rich of valuable theoretical information on the pathophysiology of elevated intracranial pressure and its bedside measurement and interpretation. We think, however, that the message put forward by this article could be made more reader friendly if the paper “part 2,” which we think will provide correlations with the clinical conditions and outcome, was presented along the present one.
Domenico d’Avella
Mario Ermani
Padova, Italy
ClinicalTrials.gov Identifier: NCT01126658
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Lai, HY., Lee, CY., Hsu, HH. et al. The intracranial volume pressure response in increased intracranial pressure patients: Part 1. Calculation of the volume pressure indicator. Acta Neurochir 154, 2271–2275 (2012). https://doi.org/10.1007/s00701-010-0765-8
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DOI: https://doi.org/10.1007/s00701-010-0765-8