Intracranial hypertension: what additional information can be derived from ICP waveform after head injury?

Détails

ID Serval
serval:BIB_8BFE3621E7A3
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Intracranial hypertension: what additional information can be derived from ICP waveform after head injury?
Périodique
Acta Neurochirurgica
Auteur(s)
Balestreri M., Czosnyka M., Steiner L.A., Schmidt E., Smielewski P., Matta B., Pickard J.D.
ISSN
0001-6268
Statut éditorial
Publié
Date de publication
2004
Peer-reviewed
Oui
Volume
146
Numéro
2
Pages
131-141
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
OBJECTIVE: Although intracranial hypertension is one of the important prognostic factors after head injury, increased intracranial pressure (ICP) may also be observed in patients with favourable outcome. We have studied whether the value of ICP monitoring can be augmented by indices describing cerebrovascular pressure-reactivity and pressure-volume compensatory reserve derived from ICP and arterial blood pressure (ABP) waveforms. METHOD: 96 patients with intracranial hypertension were studied retrospectively: 57 with fatal outcome and 39 with favourable outcome. ABP and ICP waveforms were recorded. Indices of cerebrovascular reactivity (PRx) and cerebrospinal compensatory reserve (RAP) were calculated as moving correlation coefficients between slow waves of ABP and ICP, and between slow waves of ICP pulse amplitude and mean ICP, respectively. The magnitude of 'slow waves' was derived using ICP low-pass spectral filtration. RESULTS: The most significant difference was found in the magnitude of slow waves that was persistently higher in patients with a favourable outcome (p<0.00004). In patients who died ICP was significantly higher (p<0.0001) and cerebrovascular pressure-reactivity (described by PRx) was compromised (p<0.024). In the same patients, pressure-volume compensatory reserve showed a gradual deterioration over time with a sudden drop of RAP when ICP started to rise, suggesting an overlapping disruption of the vasomotor response. CONCLUSION: Indices derived from ICP waveform analysis can be helpful for the interpretation of progressive intracranial hypertension in patients after brain trauma.
Mots-clé
Adolescent, Adult, Brain/blood supply, Brain Edema/diagnosis, Brain Edema/mortality, Brain Injuries/diagnosis, Brain Injuries/mortality, Cerebral Hemorrhage, Traumatic/diagnosis, Cerebral Hemorrhage, Traumatic/mortality, Female, Glasgow Outcome Scale, Hemodynamics/physiology, Humans, Intracranial Hypertension/diagnosis, Intracranial Hypertension/mortality, Intracranial Pressure/physiology, Male, Middle Aged, Monitoring, Physiologic, Neurologic Examination, Prognosis, Retrospective Studies, Signal Processing, Computer-Assisted, Survival Rate
Pubmed
Web of science
Création de la notice
29/12/2009 18:01
Dernière modification de la notice
20/08/2019 15:50
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