Brain Venous Blood Outflow

Czosnyka, Marek

doi:10.1007/s12028-019-00744-1

Cited by 2 publications

(2 citation statements)

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“…As cerebrovascular resistance is normally lower [11] in comparison with other systems and organs, the tidal wave assumes an amplitude lower than P1. When the buffering mechanisms described above are exhausted and intracranial hypertension (ICH) is present, there is [12] deformation of ICPW, with P2 assuming an amplitude higher than P1, and the ICPW becomes progressively pyramidal [13], with the enlargement of the time interval between P1 and P2 [7] (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

et al. 2021

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Background: Morphological alterations in intracranial pressure (ICP) pulse waveform (ICPW) secondary to intracranial hypertension (ICP >20 mmHg) and a reduction in intracranial compliance (ICC) are well known indicators of neurological severity. The exclusive exploration of modifications in ICPW after either the loss of skull integrity or surgical procedures for intracranial hypertension resolution is not a common approach studied. The present study aimed to assess the morphological alterations in ICPW among neurocritical care patients with skull defects and decompressive craniectomy (DC) by comparing the variations in ICPW features according to elevations in mean ICP values. Methods: Patients requiring ICP monitoring because of acute brain injury were included. A continuous record of 10 min-length for the beat-by-beat analysis of ICPW was performed, with ICP elevation produced by means of ultrasound-guided manual internal jugular vein compression at the end of the record. ICPW features (peak amplitude ratio (P2/P1), time interval to pulse peak (TTP) and pulse amplitude) were counterweighed between baseline and compression periods. Results were distributed for three groups: intact skull (exclusive burr hole for ICP monitoring), craniotomy/large fractures (group 2) or DC (group 3). Results: 57 patients were analyzed. A total of 21 (36%) presented no skull defects, 21 (36%) belonged to group 2, whereas 15 (26%) had DC. ICP was not significantly different between groups: ±15.11 for intact, 15.33 for group 2 and ±20.81 mmHg for group 3, with ICP-induced elevation also similar between groups (p = 0.56). Significant elevation was observed for the P2/P1 ratio for groups 1 and 2, whereas a reduction was observed in group 3 (elevation of ±0.09 for groups 1 and 2, but a reduction of 0.03 for group 3, p = 0.01), and no significant results were obtained for TTP and pulse amplitudes. Conclusion: In the present study, intracranial pressure pulse waveform analysis indicated that intracranial compliance was significantly more impaired among decompressive craniectomy patients, although ICPW indicated DC to be protective for further influences of ICP elevations over the brain. The analysis of ICPW seems to be an alternative to real-time ICC assessment.

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Section: Introductionmentioning

confidence: 99%

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

et al. 2021

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“…As cerebrovascular resistance is normally lower [11] in comparison with other systems and organs, the tidal wave assumes an amplitude lower than P1. When the buffering mechanisms described above are exhausted and intracranial hypertension (ICH) is present there is [12] deformation of ICPPW, with P2 assuming an amplitude higher than P1, and the ICPPW becomes progressively pyramidal [13], with the enlargement of time interval between P1 and P2 [7] (figure 1). Figure 1.…”

Section: Recently the International Multidisciplinary Consensus Conference On Multimodalitymentioning

confidence: 99%

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Brasil

Solla

Nogueira

et al. 2021

Preprint

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Background: Morphological alterations in intracranial pressure pulse waveform (ICPPW) secondary to intracranial hypertension (ICP >20 mmHg) and reduction in intracranial compliance (ICC) are well known indicators of neurological severity. To date, no studies have documented the ICPPW modifications after intracranial hypertension resolution with decompressive craniectomy (DC). The present study aimed to assess the morphological alterations in ICPPW among neurocritical care patients with and without DC, by comparing the variations of ICPPW features according to elevations in mean ICP values. Methods: Patients requiring ICP monitoring because of severe traumatic or spontaneous conditions were included. Mean ICP values were compared with ICPPW features (P2/P1 ratio, TTP and pulse amplitude). Elevation in ICP was produced by means of ultrasound-guided manual internal jugular veins compression. Results were distributed for three groups: intact skull (exclusive burr hole for ICP monitoring), craniotomy/large fractures (group 2) or DC (group 3). Results: 57 patients were analyzed. 21 (36%) presented no skull defects, whereas 15 (26%) had DC. ICP was not significantly different between groups: ±13.59 for intact and ±17.66 mmHg for DC, with ICP induced elevation also similar between groups (p= 0.56). Significant elevation was observed for P2/P1 ratio for groups 1 and 2, whereas reduction was observed in group 3 (elevation of ±0.09 for groups 1 and 2, whereas reduction of 0.03 for group 3, p=0.01). Conclusion: In the present study, intracranial pressure pulse waveform analysis indicated that intracranial compliance was significantly more impaired among decompressive craniectomy patients, although ICPPW indicated DC to be protective for further influences of ICP elevations over the brain. Analysis of ICPPW seems to be an alternative to real time ICC assessment.

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Brain Venous Blood Outflow

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Cited by 2 publications

References 9 publications

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

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