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Consistent Changes in Intracranial Pressure Waveform Morphology Induced by Acute Hypercapnic Cerebral Vasodilatation

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Abstract

Background

Intracranial pressure (ICP) remains a pivotal physiological signal for managing brain injury and subarachnoid hemorrhage (SAH) patients in neurocritical care units. Given the vascular origin of the ICP, changes in ICP waveform morphology could be used to infer cerebrovascular changes. Clinical validation of this association in the setting of brain trauma, and SAH is challenging due to the multi-factorial influences on, and uncertainty of, the state of the cerebral vasculature.

Methods

To gain a more controlled setting, in this articel, we study ICP signals recorded in four uninjured patients undergoing a CO2 inhalation challenge in which hypercapnia induced acute cerebral vasodilatation. We apply our morphological clustering and analysis of intracranial pressure (MOCAIP) algorithm to identify six landmarks on individual ICP pulses (based on the three established ICP sub-peaks; P1, P2, and P3) and extract 128 ICP morphological metrics. Then by comparing baseline, test, and post-test data, we assess the consistency and rate of change for each individual metric.

Results

Acute vasodilatation causes consistent changes in a total of 72 ICP pulse morphological metrics and the P2 sub-region responds to cerebral vascular changes in the most consistent way with the greatest change as compared to P1 and P3 sub-regions.

Conclusions

Since the dilation/constriction of the cerebral vasculature resulted in detectable consistent changes in ICP MOCIAP metrics, by an extended monitoring practice of ICP that includes characterizing ICP pulse morphology, one can potentially detect cerebrovascular changes, continuously, for patients under neurocritical care.

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Acknowledgments

This work is partially supported by NS059797 and R01 awards NS054881 and NS066008.

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Authors and Affiliations

  1. Neural Systems and Dynamics Laboratory, Department of Neurosurgery, David Geffen School of Medicine, University of California, 18-265 Semel, 10833 Le Conte Avenue, Box 703919, Los Angeles, CA, 90095, USA

    Shadnaz Asgari, Marvin Bergsneider, Robert Hamilton, Paul Vespa & Xiao Hu

  2. Biomedical Engineering Graduate Program, Henry Samueli School of Engineering and Applied Science, University of California, 8-265 Semel, 10833 Le Conte Avenue, Box 703919, Los Angeles, CA, 90095, USA

    Marvin Bergsneider, Robert Hamilton & Xiao Hu

  3. Neurocritical Care Program, Department of Neurosurgery, David Geffen School of Medicine, University of California, 757 Westwood Plaza, suite 6236, Los Angeles, CA, 90095, USA

    Paul Vespa

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  1. Shadnaz Asgari
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  2. Marvin Bergsneider
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  3. Robert Hamilton
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  4. Paul Vespa
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  5. Xiao Hu
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Correspondence to Xiao Hu.

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Asgari, S., Bergsneider, M., Hamilton, R. et al. Consistent Changes in Intracranial Pressure Waveform Morphology Induced by Acute Hypercapnic Cerebral Vasodilatation. Neurocrit Care 15, 55–62 (2011). https://doi.org/10.1007/s12028-010-9463-x

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  • DOI: https://doi.org/10.1007/s12028-010-9463-x

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