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Assessing Cerebral Hemodynamic Stability After Brain Injury

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Intracranial Pressure & Neuromonitoring XVI

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 126))

Abstract

Objective: Following brain injury, unstable cerebral hemodynamics can be characterized by abnormal rises in intracranial pressure (ICP). This behavior has been quantified by the RAP index: the correlation (R) between ICP pulse amplitude (A) and mean (P). While RAP could be a valuable indicator of autoregulatory processes, its prognostic ability is not well established and its validity has been questioned due to potential errors in measurement. Here, we test (1) whether RAP is a consistent measure of intracranial hemodynamics and (2) whether RAP has prognostic value in predicting hemodynamic instability following brain injury.

Materials and Methods: RAP was tested in seven brain injured patients treated in a surgical intensive care unit. A sample of ICP data was randomly chosen and segmented into 1 hour periods. Hours were then categorized as either stable, which contained no sharp rises in ICP, or unstable, which contained ≥1 sharp rise—where a sharp rise is defined as ICP exceeding a mean slope of 0.15 mmHg/s. Equal numbers of stable and unstable segments were then selected for each patient. RAP was calculated as the Pearson’s correlation coefficient between ICP pulse amplitude (AMP) and mean (mICP), determined in 6 second windows, according to established methods.

Results: Results showed that (1) average AMP and ICP levels were similar between stable and unstable periods and (2) unstable periods were identified by RAP values exceeding 0.6 with an average positive predictive value of 74%.

Conclusions: We conclude that RAP can provide a valid measure of ICP dynamics, is not affected by sensor drift, and can better distinguish periods of instability than ICP or AMP alone.

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Acknowledgements

We thank Sandia Royal, R.N., Mary Ann Brookes, R.N., and Susette Coyle, R.N., for help with patient selection/records and Martin Barboza for technical help.

Conflicts of interest statement

The authors declare that they have no financial or academic conflicts of interest.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ, USA

    Bianca Pineda, Colin Kosinski, Nam Kim & William Craelius

  2. Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Shabbar Danish

Authors
  1. Bianca Pineda
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  2. Colin Kosinski
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  3. Nam Kim
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  4. Shabbar Danish
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  5. William Craelius
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Corresponding author

Correspondence to William Craelius .

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Editors and Affiliations

  1. Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

    Thomas Heldt

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Pineda, B., Kosinski, C., Kim, N., Danish, S., Craelius, W. (2018). Assessing Cerebral Hemodynamic Stability After Brain Injury. In: Heldt, T. (eds) Intracranial Pressure & Neuromonitoring XVI. Acta Neurochirurgica Supplement, vol 126. Springer, Cham. https://doi.org/10.1007/978-3-319-65798-1_58

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  • DOI: https://doi.org/10.1007/978-3-319-65798-1_58

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  • Online ISBN: 978-3-319-65798-1

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