Intracranial Pressure Waveform: History, Fundamentals and Applications in Brain Injuries

Frigieri, Gustavo; Hayashi, Cintya Yukie; Rabelo, Ní­collas Nunes; Brasil, Sérgio

doi:10.5772/intechopen.94077

Cited by 3 publications

(3 citation statements)

References 45 publications

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“…As a diagnostic method, ONSD measurement in patients with head trauma by ocular ultrasound was introduced years ago. Measurements are performed with a linear probe 3 mm behind the optic disc, in which the presence of a hypoechoic structure with a size of up to 5 mm is normal; nevertheless, a size above 5.7 mm indicates intracerebral hypertension [ 11 ]. Changes in ONSD correlate with ICP variations, so increased ICP (in conditions such as cerebral edema) is associated with elevated ONSD.…”

Section: Discussionmentioning

confidence: 99%

The role of repeated brain computed tomography based on ultrasound monitoring of optic nerve sheath diameter after moderate traumatic brain injury

Torabi¹,

Mirhosseini²,

Mirzaee³

2023

Clin Exp Emerg Med

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Section: Discussionmentioning

confidence: 99%

The role of repeated brain computed tomography based on ultrasound monitoring of optic nerve sheath diameter after moderate traumatic brain injury

Torabi¹,

Mirhosseini²,

Mirzaee³

2023

Clin Exp Emerg Med

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“…The loss of physiological cerebrovascular autoregulation experienced by the patient with ABI results in a loss of the linear relationship between brain volume and ICP becoming exponential, meaning that a small increase in volume will induce a major increase in intracranial pressure (Langfitt curve). Moreover, the variables such as cerebral blood flow and CPP will depend directly on the mean arterial pressure and of cardiac output, hence the relevance of maintaining hemodynamic stability during CRRT ( 25 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

Continuous Renal Replacement Therapy in Acute Brain Injury

Cruz-Llanos¹,

Molano

Rizo-Topete

2022

Front. Nephrol.

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Acute brain injury is the sudden and reversible loss of brain self regulation capacity as a disruption of the blood-brain barrier that conditions metabolic and inflammatory disorders that can exacerbate acute kidney injury in a critical setting; specifically it has been described that the alterations of the internal environment that come from the severity of the acute kidney injury increases the risk of endocranial hypertension and cerebral edema; in this context, injuries should be identified and treated in a timely manner with a comprehensive approach. Continuous renal replacement therapy is an extracorporeal purification technique that has been gaining ground in the management of acute kidney injury in critically ill patients. Within its modalities, continuous venous venous hemofiltration is described as the therapy of choice in patients with acute brain injury due to its advantages in maintaining hemodynamic stability and reducing the risk of cerebral edema. Optimal control of variables such as timing to start renal replacement therapy, the prescribed dose, the composition of the replacement fluid and the anticoagulation of the extracorporeal circuit will have a significant impact on the evolution of the neurocritical patient with acute kidney injury. There are limited studies evaluating the role of hemofiltration in this context.

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“…This necessitates tight regulation of each component to maintain adequate CBF, while also limiting ICP to a homeostatic range. The characteristic ICP waveform therefore remains largely similar over time, with rhythmic fluctuations that reflect the balance of changing arterial, venous, and CSF pressures (Figures 1A, B) (Fan et al, 2008;Frigieri et al, 2021). Ideally, changing arterial pulse pressures are buffered by venous outflow and CSF production, circulation, and drainage-this keeps ICP levels within a well-regulated range (Figures 1A, B).…”

Section: Normal Icp and Intracranial Compliance Regulationmentioning

confidence: 97%

Relationship between edema and intracranial pressure following intracerebral hemorrhage in rat

Kalisvaart

Bahr²,

Colbourne³

2023

Front. Stroke

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Elevated intracranial pressure (ICP) is a potentially fatal consequence of intracerebral hemorrhage (ICH). As the mass of the hematoma and regional edema builds, ICP rises and becomes increasingly variable acutely after stroke. High ICP may worsen cellular injury and edema by impairing local tissue perfusion, fueling a cycle that may ultimately cause fatality through ischemia and brain herniation. Time spent above an ICP of 20 mmHg often predicts a greater risk of death and disability following ICH. Compensatory mechanisms combat rising ICP. Classically, these include cerebrospinal fluid volume loss and cerebrovascular autoregulation, such as a reduction in the volume of venous blood. Additional mechanisms such as brain tissue compliance and skull volume compensation may also contribute. Compensatory compliance mechanisms are limited, and they vary by age and many other factors. Animal models of ICH are widely used to assess these variables and to gauge putative therapeutics. Most often those studies rely upon simple measures of edema, which may not accurately predict ICP data. Thus, we analyzed our past studies characterizing ICP, edema, and tissue compliance responses to striatal ICH in rat, including the collagenase (C-ICH) and whole blood models (WB-ICH). We found that both ICH models raised ICP, with greater effects in the C-ICH model, which may thus better reflect clinical findings of concern. Importantly, measures of edema, such as in the damaged hemisphere, on their own are not predictive of average or peak ICP response within either model, unless assessing across a very wide range of injury severities, or when including non-stroke animals. We caution against using edema data as a surrogate measure of mass effect and ICP following ICH.

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Intracranial Pressure Waveform: History, Fundamentals and Applications in Brain Injuries

Cited by 3 publications

References 45 publications

The role of repeated brain computed tomography based on ultrasound monitoring of optic nerve sheath diameter after moderate traumatic brain injury

The role of repeated brain computed tomography based on ultrasound monitoring of optic nerve sheath diameter after moderate traumatic brain injury

Continuous Renal Replacement Therapy in Acute Brain Injury

Relationship between edema and intracranial pressure following intracerebral hemorrhage in rat

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