Advertisement

Use of ICM+ software for on-line analysis of intracranial and arterial pressures in head-injured patients

  • K. Guendling
  • P. Smielewski
  • M. Czosnyka
  • P. Lewis
  • J. Nortje
  • I. Timofeev
  • P. J. Hutchinson
  • J. D. Pickard
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 96)

Summary

Objective

To summarize our experience from the first 2 years of use of the ICM+ software in our Neurocritical Care Unit (NCCU).

Materials and methods

Ninety-five head-injured patients (74 males, 21 females), average age 36 years, were managed in the NCCU. Intracranial pressure (ICP) was monitored using Codman intraparenchymal probes and arterial blood pressure (ABP) was measured from the radial artery. Signals were monitored by ICM+ software calculating mean values of ICP, ABP, cerebral perfusion pressure (CPP) and various indices describing pressure reactivity, compensation and vascular waveforms of ICP (pulse amplitude, respiratory, and slow waves), etc.

Results

Mean ICP was 17 mmHg, mean CPP was 73 mmHg. Seven patients showed permanent disturbance of cerebral autoregulation (mean pressure reactivity index above 0.3). Pressure reactivity index demonstrated significant U-shape relationship with CPP, suggesting loss of pressure reactivity at too low (CPP < 55 mmHg) and too high CPPs (CPP > 95 mmHg). Mean ICP was inversely correlated with respiratory rate (R 0.46; p < 0.0001; reciprocal model).

Conclusion

The new version of ICM+ software proved to be useful clinically in the NCCU. It allows continuous monitoring of pressure reactivity and exploratory analysis of factors implicating intracranial hypertension.

Keywords

Head injury intracranial pressure cerebral perfusion pressure autoregulation computer monitoring 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bech-Azeddine R, Gjerris F, Waldemar G, Czosnyka M, Juhler M (2005) Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operation. Acta Neurochir (Wien) 147: 1027–1036CrossRefGoogle Scholar
  2. 2.
    Chambers IR, Treadwell L, Mendelow AD (2001) Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients. J Neurosurg 94: 412–416PubMedGoogle Scholar
  3. 3.
    Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34: 216–222PubMedCrossRefGoogle Scholar
  4. 4.
    Czosnyka M, Whitehouse H, Smielewski P, Kirkpatrick P, Guazzo EP, Pickard JD (1994) Computer supported multimodal bed-side monitoring in neuro intensive care. Int J Clin Monit Comput 11: 223–232PubMedCrossRefGoogle Scholar
  5. 5.
    Czosnyka M, Smielewski P, Piechnik S, Steiner LA, Pickard JD (2001) Cerebral autoregulation following head injury. J Neurosurg 95: 756–763PubMedCrossRefGoogle Scholar
  6. 6.
    Czosnyka M, Czosnyka Z, Momjian S, Pickard JD (2004) Cerebrospinal fluid dynamics. Physiol Meas 25: R51–R76PubMedCrossRefGoogle Scholar
  7. 7.
    Ginsberg MD, Zhao W, Alonso OF, Loor-Estades JY, Dietrich WD, Busto R (1997) Uncoupling of local cerebral glucose metabolism metabolism and blood flow after acute fluid-percussion injury in rats. Am J Physiol 272: H2859–H2868PubMedGoogle Scholar
  8. 8.
    Howells T, Elf K, Jones PA, Ronne-Engstrom E, Piper I, Nilsson P, Andrews P, Enblad P (2005) Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg 102: 311–317PubMedCrossRefGoogle Scholar
  9. 9.
    Kelly DF, Martin NA, Kordestani R, Counelis G, Hovda DA, Bergsneider M, McBride DQ, Shalmon E, Herman D, Becker DP (1997) Cerebral blood flow as a predictor of outcome following traumatic brain injury. J Neurosurg 86: 633–641PubMedCrossRefGoogle Scholar
  10. 10.
    Kett-White R, Hutchinson PJ, Czosnyka M, Boniface S, Pickard JD, Kirkpatrick PJ (2002) Multi-modal monitoring of acute brain injury. Adv Tech Stand Neurosurg 27: 87–134PubMedGoogle Scholar
  11. 11.
    Kirkpatrick PJ, Czosnyka M, Pickard JD (1996) Multimodal monitoring in neuro-intensive care. J Neurol Neurosurg Psychiatry 80: 131–139CrossRefGoogle Scholar
  12. 12.
    Miller JD, Becker DP, Ward JD, Sullivan HG, Adams WE, Rosner MJ (1977) Significance of intracranial hypertension in severe head injury. J Neurosurg 47: 503–516PubMedGoogle Scholar
  13. 13.
    Smielewski P, Czosnyka M, Zabolotny W, Kirkpatrick P, Richards HK, Pickard JD (1997) A computing system for the clinical and experimental investigation of cerebrovascular reactivity. Int J Clin Monit Comput 14: 185–198PubMedCrossRefGoogle Scholar
  14. 14.
    Steiner LA, Czosnyka M, Piechnik SK, Smielewski P, Chatfield D, Menon DK, Pickard JD (2002) Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med 30: 733–738PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • K. Guendling
    • 2
    • 1
  • P. Smielewski
    • 2
    • 3
  • M. Czosnyka
    • 2
  • P. Lewis
    • 4
  • J. Nortje
    • 5
  • I. Timofeev
    • 2
  • P. J. Hutchinson
    • 2
  • J. D. Pickard
    • 2
  1. 1.Academic NeurosurgeryAddenbrooke’s HospitalCambridgeUK
  2. 2.Academic Department of Clinical NeuroscienceAddenbrooke’s HospitalCambridgeUK
  3. 3.Department of NeurosurgeryUniversity of GiessenGiessenGermany
  4. 4.Prince Alfred HospitalMelbourneAustralia
  5. 5.Department of AnesthesiologyAddenbrooke’s HospitalCambridgeUK

Personalised recommendations