Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
It was recently found in traumatic brain injury (TBI) that ICP variability (ICPV) predicted favorable outcome. We hypothesized that ICPV may depend on intracranial compliance, unstable blood pressure and cerebral vasomotion. In this study, we aimed to further investigate the explanatory variables for ICPV and its relation to outcome. Data from 362 TBI patients were retrospectively analyzed day 2 to 5 post-injury. ICPV was evaluated in three ways. First, variability in the sub-minute time interval (similar to B waves) was calculated as the amplitude of the ICP slow waves using a bandpass filter, limiting the analysis to oscillations of 55 to 15 s (ICP AMP 55–15). The second and third ICPV measures were calculated as the deviation from the mean ICP averaged over 30 min (ICPV-30m) and 4 h (ICPV-4h), respectively. All ICPV measures were associated with a reduced intracranial pressure/volume state (high ICP and RAP) and high blood pressure variability in multiple linear regression analyses. Higher ICPV was associated with better pressure reactivity in the univariate, but not the multiple analyses. All ICPV measures were associated with favorable outcome in univariate analysis, but only ICP AMP 55–15 and ICPV-30m did so in the multiple logistic regression analysis. Higher ICPV can be explained by a reduced intracranial compliance and variations in cerebral blood volume due to the vessel response to unstable blood pressure. As ICP AMP 55–15 and ICPV-30m independently predicted favorable outcome, it may represent general cerebral vessel activity, associated with better cerebral blood flow regulation and less secondary insults.
Peeters W, van den Brande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, Maas AI. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien). 2015;157(10):1683–96. CrossRef
Fischerström A, Nyholm L, Lewén A, Enblad P. Acute neurosurgery for traumatic brain injury by general surgeons in Swedish county hospitals: a regional study. Acta Neurochir (Wien). 2014;156(1):177–85. CrossRef
Nyholm L, Howells T, Enblad P, Lewén A. Introduction of the Uppsala Traumatic Brain Injury register for regular surveillance of patient characteristics and neurointensive care management including secondary insult quantification and clinical outcome. Ups J Med Sci. 2013;118(3):169–80. CrossRefPubMedPubMedCentral
Wettervik TS, Lenell S, Nyholm L, Howells T, Lewén A, Enblad P. Decompressive craniectomy in traumatic brain injury: usage and clinical outcome in a single centre. Acta Neurochir (Wien). 2018;160(2):229–37. CrossRef
Elf K, Nilsson P, Enblad P. Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care. Crit Care Med. 2002;30(9):2129–34. https://doi.org/10.1097/01.Ccm.0000025893.73582.52. CrossRefPubMed
Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15. https://doi.org/10.1227/neu.0000000000001432. CrossRefPubMedPubMedCentral
Spiegelberg A, Preuß M, Kurtcuoglu V. B-waves revisited. Interdisciplinary. Neurosurgery. 2016;6:13–7.
Rosner M (1986) The vasodilatory cascade and intracranial pressure. In: Intracranial pressure VI. Springer, pp 137–141.
Lundberg N, Troupp H, Lorin H. Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg. 1965;22(6):581–90. https://doi.org/10.3171/jns.1965.22.6.0581. CrossRefPubMed
- Intracranial pressure variability: relation to clinical outcome, intracranial pressure–volume index, cerebrovascular reactivity and blood pressure variability
Teodor Svedung Wettervik
- Springer Netherlands
Journal of Clinical Monitoring and Computing
Print ISSN: 1387-1307
Elektronische ISSN: 1573-2614
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II