Analysis of intracranial pressure pulse waveform in traumatic brain injury patients: a CENTER-TBI study

Abstract

OBJECTIVE Intracranial pressure (ICP) pulse waveform analysis may provide valuable information about cerebrospinal pressure-volume compensation in patients with traumatic brain injury (TBI). The authors applied spectral methods to analyze ICP waveforms in terms of the pulse amplitude of ICP (AMP), high frequency centroid (HFC), and higher harmonics centroid (HHC) and also used a morphological classification approach to assess changes in the shape of ICP pulse waveforms using the pulse shape index (PSI). METHODS The authors included 184 patients from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) High-Resolution Sub-Study in the analysis. HFC was calculated as the average power-weighted frequency within the 4- to 15-Hz frequency range of the ICP power density spectrum. HHC was defined as the center of mass of the ICP pulse waveform harmonics from the 2nd to the 10th. PSI was defined as the weighted sum of artificial intelligence–based ICP pulse class numbers from 1 (normal pulse waveform) to 4 (pathological waveform). RESULTS AMP and PSI increased linearly with mean ICP. HFC increased proportionally to ICP until the upper breakpoint (average ICP of 31 mm Hg), whereas HHC slightly increased with ICP and then decreased significantly when ICP exceeded 25 mm Hg. AMP (p < 0.001), HFC (p = 0.003), and PSI (p < 0.001) were significantly greater in patients who died than in patients who survived. Among those patients with low ICP (< 15 mm Hg), AMP, PSI, and HFC were greater in those with poor outcome than in those with good outcome (all p < 0.001). CONCLUSIONS Whereas HFC, AMP, and PSI could be used as predictors of mortality, HHC may potentially serve as an early warning sign of intracranial hypertension. Elevated HFC, AMP, and PSI were associated with poor outcome in TBI patients with low ICP.

Quantitative analysis of similarity between cerebral arterial blood volume and intracranial pressure pulse waveforms during intracranial pressure plateau waves

“…Moreover, TBI patients often experience disturbances in cerebral autoregulation which can further amplify this phenomenon. Previous studies have also observed alterations in the shape of ICP pulse waveforms toward more pathologically rounded pulses in TBI patients, even at mean ICP levels below 20 mm Hg ( Hawthorne and Piper, 2014 ; Kazimierska et al, 2021 ; Mataczynski et al, 2022 ; Uryga et al, 2022 ), which suggests that cerebrospinal compliance is often reduced in this population. When intracranial compensatory reserve is depleted (i.e., cerebrospinal compliance is low), pulsatile changes in C a BV appear to be more directly transmitted to the ICP signal.…”

Continuous monitoring methods of cerebral compliance and compensatory reserve: a scoping review of human literature

“…This review includes 43 studies (Czosnyka et al 1988, 1994, 1996, Balestreri et al 2004, Steiner et al 2005, Petrella et al 2008, Schuhmann et al 2008, Shahsavari et al 2008, Smielewski et al 2008, Timofeev et al 2008a, 2008b, Kim et al 2009a, Weerakkody et al 2011, Budohoski et al 2012, Howells et al 2012, Speil et al 2012, Eide and Sorteberg 2013, Haubrich et al 2013, 2016a, 2016b, Pineda et al 2015, Varsos et al 2015, Moyse et al 2016, Calviello et al 2018, Zeiler et al 2018a, 2018b, Jin et al 2019, Sekhon et al 2019, Donnelly et al 2020, Froese et al 2020, Lalou et al 2020, Green et al 2021, Levrini et al 2021, Ziółkowski et al 2021, Liu et al 2022, Uryga et al 2022, Zhu et al 2023 that measured and assessed CC/ CCR continuously using the RAP metric, 11 studies (Piper et al 1999, Raabe et al 1999, Kiening et al 2002, Yau et al 2002, Abdullah et al 2005, Ng et al 2005…”

A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts

“…Brasil et al [16] found the P2/P1 ratio to increase around 10% after promoting an ICP increase of ~ 4 mm Hg from a baseline of ~ 15 mm Hg in a study of patients with TBI without skull damage. Integrated artificial intelligence-based pulse shape index tracing continuously P2 to P1 proportions has recently been proven to associate both with outcome after TBI and CT findings [65,66]. The time to peak (TTP) is a normalized parameter derived from each pulse triggering up to its highest amplitude [67,68].…”