Abstract
The incidence of traumatic brain injury (TBI) has been increasing globally and is estimated at 27–69 million of new cases per year. It remains the main single cause of death in young people below 40 years of age. The ultimate extent of brain injury and the patient’s outcome result from the degree of primary damage to the central nervous system at the time of impact and the subsequent, pathophysiological sequelae of injury expansion over following hours and days. Clinical management of TBI aims to interrupt the pathological cascade of events and minimise development of secondary damage. Although the entire spectrum of complex, multilevel processes occurring in injured regions of the brain and the peri-lesional penumbra are not fully studied and understood, important part of treatment protocols constitutes invasive monitoring of brain physiology. Intracranial pressure (ICP) measurement plays a key role as a diagnostic tool in critical care of TBI patients. ICP and its derivates are indirect source of data on status of brain autoregulation, intracranial compliance, and compensatory reserve. The pressure reactivity index reflects the condition of cerebrovascular reactivity and indicates an individual, optimal cerebral perfusion pressure. Moreover, the real-time observation of continuous ICP waveform does not only alert clinicians of intracranial hypertension but delivers prognostic information.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34(2):216–22.
Albeck MJ, Børgesen SE, Gjerris F, Schmidt JF, Sørensen PS. Intracranial pressure and cerebrospinal fluid outflow conductance in healthy subjects. J Neurosurg. 1991;74(4):597–600.
Welch K. The intracranial pressure in infants. J Neurosurg. 1980;52(5):693–9.
Mazzola CA, Adelson PD. Critical care management of head trauma in children. Crit Care Med. 2002;30(11):393–401.
Chapman PH, Cosman ER, Arnold MA. The relationship between ventricular fluid pressure and body position in normal subjects and subjects with shunts: a telemetric study. Neurosurgery. 1990;26(2):181–9.
Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15.
Sorrentino E, Diedler J, Kasprowicz M, Budohoski KP, Haubrich C, Smielewski P, Outtrim JG, Manktelow A, Hutchinson PJ, Pickard JD, Menon DK, Czosnyka M. Critical thresholds for cerebrovascular reactivity after traumatic brain injury. Neurocrit Care. 2012;16(2):258–66.
Monro A. Observations on the structure and function of the nervous system. Edinburgh: Creech & Johnson; 1783.
Mokri B. The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology. 2001;56(12):1746–8.
Klatzo I. Neuropathological aspects of brain edema. J Neuropathol Exp Neurol. 1967;26(1):1–14.
Hawthorne C, Piper I. Monitoring of intracranial pressure in patients with traumatic brain injury. Front Neurol. 2014;5:121.
Ocamoto GN, Russo TL, Mendes Zambetta R, Frigieri G, Hayashi CY, Brasil S, Rabelo NN, Spavieri Júnior DL. Intracranial compliance concepts and assessment: a scoping review. Front Neurol. 2021;12:756112.
Avezaat CJ, van Eijndhoven JH, Wyper DJ. Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psychiatry. 1979;42(8):687–700.
Rowed DW, Leech PJ, Reilly PL, Miller JD. Hypocapnia and intracranial volume-pressure relationship. A clinical and experimental study. Arch Neurol. 1975;32(6):369–73.
Marmarou A, Shulman K, Rosende RM. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg. 1978;48(3):332–44.
Harary M, Dolmans RGF, Gormley WB. Intracranial pressure monitoring—review and avenues for development. Sensors. 2018;18(2):465.
Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl. 1960;36(149):1–193.
Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry. 2004;75(6):813–21.
Zakrzewska AP, Placek MM, Czosnyka M, Kasprowicz M, Lang EW. Intracranial pulse pressure waveform analysis using the higher harmonics centroid. Acta Neurochir. 2021;163(12):3249–58.
Dias C, Maia I, Cerejo A, Varsos G, Smielewski P, Paiva JA, Czosnyka M. Pressures, flow, and brain oxygenation during plateau waves of intracranial pressure. Neurocrit Care. 2014;21(1):124–32.
Martinez-Tejada I, Arum A, Wilhjelm JE, Juhler M, Andresen M. B waves: a systematic review of terminology, characteristics, and analysis methods. Fluids Barriers CNS. 2019;16(1):33.
Skippen P, Seear M, Poskitt K, Kestle J, Cochrane D, Annich G, Handel J. Effect of hyperventilation on regional cerebral blood flow in head-injured children. Crit Care Med. 1997;25(8):1402–9.
Cardoso ER, Rowan JO, Galbraith S. Analysis of the cerebrospinal fluid pulse wave in intracranial pressure. J Neurosurg. 1983;59(5):817–21.
Hu X, Glenn T, Scalzo F, Bergsneider M, Sarkiss C, Martin N, Vespa P. Intracranial pressure pulse morphological features improved detection of decreased cerebral blood flow. Physiol Meas. 2010;31(5):679–95.
Robertson CS, Narayan RK, Contant CF, Grossman RG, Gokaslan ZL, Pahwa R, Caram P Jr, Bray RS Jr, Sherwood AM. Clinical experience with a continuous monitor of intracranial compliance. J Neurosurg. 1989;71(5):673–80.
Kety SS, Schmidt CF. The nitrous oxide method for the quantitative determination of cerebral blood flow in man: theory, procedure and normal values. J Clin Invest. 1948;27(4):476–83.
Gibbs E, Lennox W, Nims L, Gibbs F. Arterial and cerebral venous blood: arterial-venous differences in man. J Biol Chem. 1942;144:325–32.
Winn HR. Youmans neurological surgery. 5th ed. Philadelphia: Elsevier; 2004.
Rowe GG, Maxwell GM, Castillo CA, Freeman DJ, Crumpton CW. A study in man of cerebral blood flow and cerebral glucose, lactate and pyruvate metabolism before and after eating. J Clin Invest. 1959;38(12):2154–8.
Robertson CS, Narayan RK, Gokaslan ZL, Pahwa R, Grossman RG, Caram P Jr, Allen E. Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg. 1989;70(2):222–30.
Bouma GJ, Muizelaar JP, Choi SC, Newlon PG, Young HF. Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg. 1991;75(5):685–93.
Lassen NA. Cerebral blood flow and oxygen consumption in man. Physiol Rev. 1959;39(2):183–238.
Rosner MJ, Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg. 1986;65(5):636–41.
Donnelly J, Czosnyka M, Adams H, Cardim D, Kolias AG, Zeiler FA, Lavinio A, Aries M, Robba C, Smielewski P, Hutchinson PJA, Menon DK, Pickard JD, Budohoski KP. Twenty-five years of intracranial pressure monitoring after severe traumatic brain injury: a retrospective, single-center analysis. Neurosurgery. 2019;85(1):E75–82.
Kontos HA, Wei EP, Navari RM, Levasseur JE, Rosenblum WI, Patterson JL Jr. Responses of cerebral arteries and arterioles to acute hypotension and hypertension. Am J Physiol. 1978;234(4):H371–83.
Heistad D, Kontos H. Handbook of physiology. Bethesda: American Physiological Society; 1983.
Lang EW, Chesnut RM. Intracranial pressure. Monitoring and management. Neurosurg Clin N Am. 1994;5(4):573–605.
Sheinberg M, Kanter MJ, Robertson CS, Contant CF, Narayan RK, Grossman RG. Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg. 1992;76(2):212–7.
Gopinath SP, Robertson CS, Contant CF, Hayes C, Feldman Z, Narayan RK, Grossman RG. Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry. 1994;57(6):717–23.
Oertel M, Kelly DF, Lee JH, McArthur DL, Glenn TC, Vespa P, Boscardin WJ, Hovda DA, Martin NA. Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury. J Neurosurg. 2002;97(5):1045–53.
Enevoldsen EM, Jensen FT. Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury. J Neurosurg. 1978;48(5):689–703.
Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA. Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg. 1984;61(2):241–53.
Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD. Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery. 1997;41(1):11–7.
Balestreri M, Czosnyka M, Steiner LA, Hiler M, Schmidt EA, Matta B, Menon D, Hutchinson P, Pickard JD. Association between outcome, cerebral pressure reactivity and slow ICP waves following head injury. Acta Neurochir Suppl. 2005;95:25–8.
Steiner LA, Czosnyka M, Piechnik SK, Smielewski P, Chatfield D, Menon DK, Pickard JD. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002;30(4):733–8.
Aries MJ, Czosnyka M, Budohoski KP, Steiner LA, Lavinio A, Kolias AG, Hutchinson PJ, Brady KM, Menon DK, Pickard JD, Smielewski P. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med. 2012;40(8):2456–63.
Czosnyka M, Smielewski P, Timofeev I, Lavinio A, Guazzo E, Hutchinson P, Pickard JD. Intracranial pressure: more than a number. Neurosurg Focus. 2007;22(5):E10.
Czosnyka M, Guazzo E, Whitehouse M, Smielewski P, Czosnyka Z, Kirkpatrick P, Piechnik S, Pickard JD. Significance of intracranial pressure waveform analysis after head injury. Acta Neurochir. 1996;138(5):531–41; discussion 541-2.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Zakrzewska, A., Pelah, A., Czosnyka, M. (2024). Interactions Between Volumes, Flows and Pressures in the Brain: Intracranial Pressure, Cerebral Perfusion Pressure, Cerebral Autoregulation and the Concept of Compensatory Reserve. In: Brogi, E., Coccolini, F., Ley, E.J., Valadka, A. (eds) Traumatic Brain Injury. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-031-50117-3_7
Download citation
DOI: https://doi.org/10.1007/978-3-031-50117-3_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-50116-6
Online ISBN: 978-3-031-50117-3
eBook Packages: MedicineMedicine (R0)