Abstract
Experiments have shown that closed-box conditions alter the transmission of respiratory oscillations (R waves) to organ blood flow already at a marginal pressure increase. How does the increasing intracranial pressure (ICP) interact with R waves in cerebral blood flow after head injury (HI)?
Twenty-two head-injured patients requiring sedation and mechanical ventilation were monitored for ICP, Doppler flow velocity (FV) in the middle cerebral arteries, and arterial blood pressure (ABP). The analysis included transfer function gains of R waves (9–20 cpm) from ABP to FV, and indices of pressure–volume reserve (RAP) and autoregulation (Mx). Increasing ICP has dampened R-wave gains from day 1 to day 4 after HI in all patients. A large impact (ΔGain /ΔICP right: 0.14 ± 0.06; left: 0.18 ± 0.08) was associated with exhausted reserves (RAP ≥0.85). When RAP was <0.85, rising ICP had a lower impact on R-wave gains (ΔGain /ΔICP right: 0.05 ± 0.02; left: 0.06 ± 0.04; p < 0.05), but increased the pulsatility indices (right: 1.35 ± 0.55; left: 1.25 ± 0.52) and Mx indices (right: 0.30 ± 0.12; left: 0.28 ± 0.08, p < 0.05). Monitoring of R waves in blood pressure and cerebral blood flow velocity has suggested that rising ICP after HI might have an impact on cerebral blood flow directly, even before autoregulation is impaired.
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Abbreviations
- ABP:
-
Arterial blood pressure
- CoV:
-
Coefficient of variance
- CPP:
-
Cerebral perfusion pressure
- FV:
-
Cerebral blood flow velocity
- Gain:
-
Transfer function gain
- HI:
-
Head injury
- ICP:
-
Intracranial pressure
- Mx:
-
Index for cerebral autoregulation
- PI:
-
Pulsatility index
- RAP:
-
Index for pressure–volume reserve
References
Hu X, Alwan AA, Rubinstein EH, Bergsneider M (2006) Reduction of compartment compliance increases venous flow pulsatility and lowers apparent vascular compliance: implications for cerebral blood flow hemodynamics. Med Eng Phys 28:304–314
Giller CA, Ratcliff B, Berger B, Giller A (1996) An impedance index in normal subjects and in subarachnoid hemorrhage. Ultrasound Med Biol 22:373–382
Haubrich C, Diehl RR, Kasprowicz M, Diedler J, Sorrentino E, Smielewski P, Czosnyka M (2015) Traumatic brain injury: increasing ICP attenuates respiratory modulations of cerebral blood flow velocity. Medical Engineering & Physics 37(2):175–179
Lescot T, Reina V, Le Manach Y, Boroli F, Chauvet D, Boch AL, Puybasset L (2011) In vivo accuracy of two intraparenchymal intracranial pressure monitors. Intensive Care Med 37(5):875–879
Diehl RR, Linden D, Lücke D, Berlit P (1998) Spontaneous blood pressure oscillations and cerebral autoregulation. Clin Auton Res 8:7–12
Czosnyka M, Pickard JD (2004) Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 75:813–821
Haubrich C, Czosnyka Z, Lavinio A, Smielewski P, Diehl RR, Pickard JD, Czosnyka M (2007) Is there a direct link between cerebrovascular activity and CSF pressure-volume compensation? Stroke 38:2677–2680
Acknowledgments
The authors are in debt to the whole team participating in data collection and all the nursing and research staff at the Department of Neurosurgery.
Funding Disclosure
Dr C. Haubrich was supported by a Feodor-Lynen scholarship of the Alexander-von-Humboldt Foundation; Dr M. Kasprowicz was a scholar of the Foundation for Polish Science, Dr M. Czosnyka and Dr P. Smielewski are supported by MRC grant No.: G9439390, ID 65883. Dr M. Czosnyka is on unpaid leave from Warsaw University.
Conflict of Interest Disclosure
ICM+ software (www.neurosurg.cam.ac.uk/icmplus) is licensed by the University of Cambridge – UK, and P. Smielewski and M. Czosnyka have a financial interest in the licensing fee.
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Haubrich, C. et al. (2016). Increasing Intracranial Pressure After Head Injury: Impact on Respiratory Oscillations in Cerebral Blood Flow Velocity. In: Ang, BT. (eds) Intracranial Pressure and Brain Monitoring XV. Acta Neurochirurgica Supplement, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-22533-3_35
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DOI: https://doi.org/10.1007/978-3-319-22533-3_35
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