Compliance of the cerebrospinal space: comparison of three methods

Kazimierska, Agnieszka; Kasprowicz, Magdalena; Czosnyka, Marek; Plaček, Michal; Balédent, Olivier; Smielewski, Peter; Czosnyka, Zofia

doi:10.1007/s00701-021-04834-y

Cited by 40 publications

(52 citation statements)

References 30 publications

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“…ICP invasive monitoring in COVID-19 patients would have been unethical and difficult to implement. The B4C device does not provide ICP values; however, it allows a bedside observation and report of the ICP pulse waveform quantitative parameters, a vital sign that is gaining attention in recent years [36,37]. Studies evaluating this ICC device in critically ill patients are few and still ongoing [38]; nevertheless, ICC was adequately assessed in children with hydrocephalus [21] and in experimental studies using this technique [39].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study

et al. 2021

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Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00–1.28] vs. 1.00 [0.88–1.16]; p = 0.03) and eICP (14 [11–25] vs. 11 [7–15] mmHg; p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8–12] vs. 6 [5–7]; p < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75–0.97); a score > 8.5 had 63 (46–77)% sensitivity and 87 (62–97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5–31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome.

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Section: Discussionmentioning

confidence: 99%

Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study

et al. 2021

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“…ICC is a property of dynamic volumes inside a cavity whose expansion is very limited, indicating the hemostasis amongst them [1]. In addition, ICC may reflect the compensatory changes of vessels (mainly the great intracranial venous sinuses) and the CSF spaces (cisterns, ventricles and subarachnoid), according to ICP elevations [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Likewise, in recent years the knowledge on the ICP pulse waveform (ICPW) has advanced, as well as its clinical application. ICPW is an early marker of ICC impairment [3,[7][8][9] and is mainly represented by three distinct peaks: P1 (percussion wave), P2 (tidal wave) and P3 (dicrotic wave) [10]. Under physiologic conditions, P1 produced by arterial contraction is the highest peak observed, with P2 reflecting both vascular and ventricular repercussion of pressure pulse spread.…”

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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“…Although not statistically significant, DC patients disclosed higher baseline mean ICP levels and P2/P1 ratio, with a significant decrease in the latter when ICP elevation was induced. Thus, the study demonstrated that P2/P1 ratio may bring additional information for neuromonitoring [3,18] and the effect of DC that not just ameliorated ICP but also increased the intracranial compliance, protecting for further elevations in ICP. This agrees with previous studies using different methodologies [19][20][21].…”

Section: Discussionmentioning

confidence: 73%

“…Likewise, in recent years the knowledge on the ICP pulse waveform (ICPPW) has advanced, as well as its clinical application. ICPPW is an early marker of ICC impairment [3,[7][8][9] and is mainly represented by three distinct peaks, P1 (percussion wave), P2 (tidal wave) and P3 (dicrotic wave) [10].…”

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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Compliance of the cerebrospinal space: comparison of three methods

Cited by 40 publications

References 30 publications

Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study

Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

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