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Changes in Cerebral Partial Oxygen Pressure and Cerebrovascular Reactivity During Intracranial Pressure Plateau Waves

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Abstract

Background

Plateau waves in intracranial pressure (ICP) are frequently recorded in neuro intensive care and are not yet fully understood. To further investigate this phenomenon, we analyzed partial pressure of cerebral oxygen (pbtO2) and a moving correlation coefficient between ICP and mean arterial blood pressure (ABP), called PRx, along with the cerebral oxygen reactivity index (ORx), which is a moving correlation coefficient between cerebral perfusion pressure (CPP) and pbtO2 in an observational study.

Methods

We analyzed 55 plateau waves in 20 patients after severe traumatic brain injury. We calculated ABP, ABP pulse amplitude (ampABP), ICP, CPP, pbtO2, heart rate (HR), ICP pulse amplitude (ampICP), PRx, and ORx, before, during, and after each plateau wave. The analysis of variance with Bonferroni post hoc test was used to compare the differences in the variables before, during, and after the plateau wave. We considered all plateau waves, even in the same patient, independent because they are separated by long intervals.

Results

We found increases for ICP and ampICP according to our operational definitions for plateau waves. PRx increased significantly (p = 0.00026), CPP (p < 0.00001) and pbtO2 (p = 0.00007) decreased significantly during the plateau waves. ABP, ampABP, and HR remained unchanged. PRx during the plateau was higher than before the onset of wave in 40 cases (73 %) with no differences in baseline parameters for those with negative and positive ΔPRx (difference during and after). ORx showed an increase during and a decrease after the plateau waves, however, not statistically significant. PbtO2 overshoot after the wave occurred in 35 times (64 %), the mean difference was 4.9 ± 4.6 Hg (mean ± SD), and we found no difference in baseline parameters between those who overshoot and those who did not overshoot.

Conclusions

Arterial blood pressure remains stable in ICP plateau waves, while cerebral autoregulatory indices show distinct changes, which indicate cerebrovascular reactivity impairment at the top of the wave. PbtO2 decreases during the waves and may show a slight overshoot after normalization. We assume that this might be due to different latencies of the cerebral blood flow and oxygen level control mechanisms. Other factors may include baseline conditions, such as pre-plateau wave cerebrovascular reactivity or pbtO2 levels, which differ between studies.

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Acknowledgments

Magdalena Kasprowicz is the recipient of a scholarship funded by the Polish Ministry of Science and Higher Education. All authors thank the Neurocritical Care Unit staff members at Addenbrooke’s Hospital, UK, for their active involvement and support during the study.

Disclosure

The software for brain monitoring ICM+ is licensed by the University of Cambridge (Cambridge Enterprise). Peter Smielewski and Marek Czosnyka have financial interests in a part of the licensing fee. Erhard Lang and Marek Czosnyka are members of the Integra Speakers’ bureau. Erhard Lang is a medical advisor for GMS/Integra. All other authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Neurosurgical Associates, Red Cross Hospital, Bergmannstrasse 30, 34121, Kassel, Germany

    Erhard W. Lang

  2. Institute of Biomedical Engineering and Instrumentation, Wroclaw University of Technology, Wroclaw, Poland

    Magdalena Kasprowicz

  3. Department of Neurosurgery, Addenbrookes’s Hospital, University of Cambridge, Cambridge, UK

    Peter Smielewski, John Pickard & Marek Czosnyka

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  1. Erhard W. Lang
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  2. Magdalena Kasprowicz
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Correspondence to Erhard W. Lang.

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Lang, E.W., Kasprowicz, M., Smielewski, P. et al. Changes in Cerebral Partial Oxygen Pressure and Cerebrovascular Reactivity During Intracranial Pressure Plateau Waves. Neurocrit Care 23, 85–91 (2015). https://doi.org/10.1007/s12028-014-0074-9

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