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Plateau Waves in Head Injured Patients Requiring Neurocritical Care

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Abstract

Object

Plateau waves often develop in neurointensive care patients. They are sudden increases in intracranial pressure (ICP) that lead to dramatic decreases of cerebral perfusion pressure (CPP) and can therefore contribute to ischemic secondary brain insult. The aim of this study was to analyze the occurrence of plateau waves in head injured patients requiring neurocritical care, their relation with cerebral autoregulation and impact on outcome.

Methods

Data were analyzed retrospectively in 444 head injured patients admitted to Neuroscience Critical Care Unit of Addenbrooke’s Hospital in Cambridge, UK. Arterial blood pressure (ABP), intracranial pressure (ICP), heart rate (HR) were digitally recorded and derived indices calculated. Primary monitoring data, autoregulation indices, outcome of patients, initial CT findings (in a subgroup of patients), brain tissue monitoring data (in a subgroup) were compared between patients who developed plateau waves and those who did not.

Results

Plateau waves were observed in 109/444 patients (24.5%). They were significantly more frequent in younger patients. Impaired cerebrovascular pressure reactivity and depleted compensatory reserve were associated with vasodilatation on the top of the wave. Plateau waves were not associated with poorer outcome unless the episodes lasted for a long time (longer than 30–40 min). Plateau waves were more frequently seen in patients with lesser midline shift, lower volume of contusion on CT scan, absence of skull fractures, and lower brain tissue concentration of carbon dioxide.

Conclusions

Plateau waves are frequent phenomenon. They are not associated with worse outcome unless they lead to sustained intracranial hypertension.

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Acknowledgment

The authors are in debt to all the team participating in data collection: Mrs. Pippa Al-Rawi, Mrs. Helen Seley, Mrs. Carole Turner, Dr. Marcella Balestreri, Dr. Magda Hiler, Dr. Luzius Steiner, Dr. Eric Schmidt, Dr. Stefan Piechnik, Dr. Andreas Raabe, Mr. Eric Guazzo, Dr. David Menon, Dr. Arun Gupta, Dr. Basil Matta, Mr. Peter Kirkpatrick, Mr. Ivan Timofyeyev, Mr. Pwawanjit Minhas, Mr. Rodney Laing, and all nursing and research staff of NCCU and Wolfson Brain Imaging Centre. The project was supported by National institute of Health Research Biomedical Research center, Cambridge University Hospital Foundation Trust—Neurosciences Theme. Further support was achieved from the Swiss National Science Foundation (PBBSP3-125550 to CZ and PASSMP3-124262 to EC), Bern, Switzerland. EC was additionally supported by the SICPA Foundation, Lausanne, Switzerland.

Disclosure

ICM+ software (www.neurosurg.cam.ac.uk/icmplus) is licensed by University of Cambridge, Cambridge Enterprise Ltd. PS and MC have a financial interest in a part of licensing fee. Dr. Marek Czosnyka is on unpaid leave from Warsaw University of Technology.

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Authors and Affiliations

  1. Academic Neurosurgical Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Gianluca Castellani, Christian Zweifel, Dong-Joo Kim, Emmanuel Carrera, Danila K. Radolovich, Piotr Smielewski, Peter J. Hutchinson, John D. Pickard & Marek Czosnyka

  2. Anaesthesia and Intensive Care School, University of Pavia, Pavia, Italy

    Gianluca Castellani

  3. Department of Engineering, University of Cambridge, Cambridge, UK

    Dong-Joo Kim

  4. Servizio di Anestesia e Rianimazione 2, Policlinico San Matteo, Pavia, Italy

    Danila K. Radolovich

  5. Department of Clinical Neurosciences, Neurosurgery Unit, Addenbrooke’s Hospital, University of Cambridge, Level 4, A ward, Box 167, Cambridge, CB2 2QQ, UK

    Marek Czosnyka

Authors
  1. Gianluca Castellani
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  2. Christian Zweifel
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  3. Dong-Joo Kim
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  4. Emmanuel Carrera
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  5. Danila K. Radolovich
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  6. Piotr Smielewski
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  7. Peter J. Hutchinson
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  8. John D. Pickard
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  9. Marek Czosnyka
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Corresponding author

Correspondence to Marek Czosnyka.

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Castellani, G., Zweifel, C., Kim, DJ. et al. Plateau Waves in Head Injured Patients Requiring Neurocritical Care. Neurocrit Care 11, 143–150 (2009). https://doi.org/10.1007/s12028-009-9235-7

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  • DOI: https://doi.org/10.1007/s12028-009-9235-7

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