4.4 Article

Continuous Monitoring of Cerebrovascular Reactivity Using Pulse Waveform of Intracranial Pressure

Journal

NEUROCRITICAL CARE
Volume 17, Issue 1, Pages 67-76

Publisher

HUMANA PRESS INC
DOI: 10.1007/s12028-012-9687-z

Keywords

Brain injuries; Intracranial pressure; Physiological adaptation; Outcome assessment; Wavelet analysis

Funding

  1. Netherlands Organisation for Health Research and Development
  2. European Federation of Neurological Societies (EFNS)
  3. Royal College of Surgeons of England
  4. National Institute for Health Research (NIHR)
  5. Raymond and Beverly Sackler Studentship
  6. Medical Research Council (MRC)
  7. Medical Research Council [G0600986, G0001354, G1000183B, G0001354B, G9439390, G0001237] Funding Source: researchfish
  8. National Institute for Health Research [NF-SI-0508-10327] Funding Source: researchfish
  9. MRC [G9439390, G0001237, G0600986] Funding Source: UKRI

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Guidelines for the management of traumatic brain injury (TBI) call for the development of accurate methods for assessment of the relationship between cerebral perfusion pressure (CPP) and cerebral autoregulation and to determine the influence of quantitative indices of pressure autoregulation on outcome. We investigated the relationship between slow fluctuations of arterial blood pressure (ABP) and intracranial pressure (ICP) pulse amplitude (an index called PAx) using a moving correlation technique to reflect the state of cerebral vasoreactivity and compared it to the index of pressure reactivity (PRx) as a moving correlation coefficient between averaged values of ABP and ICP. A retrospective analysis of prospective 327 TBI patients (admitted on neurocritical care unit of a university hospital in the period 2003-2009) with continuous ABP and ICP monitoring. PAx was worse in patients who died compared to those who survived (-0.04 +/- A 0.15 vs. -0.16 +/- A 0.15, chi(2) = 28, p < 0.001). In contrast to PRx, PAx was able to differentiate between fatal and non-fatal outcome in a group of 120 patients with ICP levels below 15 mmHg (-0.04 +/- A 0.16 vs. -0.14 +/- A 0.16, chi(2) = 6, p = 0.01). PAx is a new modified index of cerebrovascular reactivity which performs equally well as established PRx in long-term monitoring in severe TBI patients, but importantly is potentially more robust at lower values of ICP. In view of establishing an autoregulation-oriented CPP therapy, continuous determination of PAx is feasible but its value has to be evaluated in a prospective controlled trail.

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