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Association between outcome, cerebral pressure reactivity and slow ICP waves following head injury

  • M. Balestreri
  • M. CzosnykaEmail author
  • L. A. Steiner
  • M. Hiler
  • E. A. Schmidt
  • B. Matta
  • D. Menon
  • P. Hutchinson
  • J. D. Pickard
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 95)

Summary

Objective

To investigate the relationships between slow vasogenic waves (‘B waves’) of intracranial pressure (ICP), pressure-reactivity and outcome after traumatic brain injury.

Material and method

193 head-injured patients (age 34±16.7 years; median GCS 6) were monitored from 1997 to 2002. ICP, arterial blood pressure (ABP) were continuously monitored. Pressure-reactivity index (PRx) and magnitude of ICP slow waves were evaluated using the bed-side computers.

Results

Distribution of PRx in different outcome groups indicated that pressure-reactivity was significantly worse in patients with fatal outcome. A magnitude of spontaneous slow waves of ICP was gradually decreasing in poorer outcome grades.

Mortality indicated threshold rise from 20% to 70% when averaged PRx increased above 0.3 (p < 0.01). There was no threshold for mortality observed along distribution of magnitude of ICP slow waves. Mortality gradually increased when the magnitude of slow waves decreased (R =−0.26; p < 0.0001).

Conclusion

Inadequate pressure-reactivity and low magnitude of slow vasogenic waves of ICP are associated with fatal outcome after head injury. Based on brain monitoring data, differentiation between favourable outcome and severe disability is more problematic than differentiation between survivors and non-survivors.

Keywords

Head injury pressure reactivity slow waves outcome 

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • M. Balestreri
    • 1
    • 2
  • M. Czosnyka
    • 1
    Email author
  • L. A. Steiner
    • 1
    • 3
  • M. Hiler
    • 1
  • E. A. Schmidt
    • 1
    • 4
  • B. Matta
    • 5
  • D. Menon
    • 5
  • P. Hutchinson
    • 1
  • J. D. Pickard
    • 1
  1. 1.Academic NeurosurgeryAddenbrooke’s HospitalCambridgeUK
  2. 2.Department of Anaesthesia and Intensive Care (IInd) Policlinico San MatteoPaviaItaly
  3. 3.Department of AnaesthesiaUniversity Hospital BaselBaselSwitzerland
  4. 4.Department of NeurosurgeryHopital PurpanToulouseFrance
  5. 5.Department of AnaesthesilogyAddenbrooke’s HospitalCambridgeUK

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