Intracranial pulse pressure waveform analysis using the higher harmonics centroid.
ICP monitoring
Intracranial pressure
Intracranial pressure pulse waveform
Plateau waves
Traumatic brain injury
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
24
05
2021
accepted:
25
07
2021
pubmed:
14
8
2021
medline:
24
11
2021
entrez:
13
8
2021
Statut:
ppublish
Résumé
The pulse waveform of intracranial pressure (ICP) is its distinctive feature almost always present in the clinical recordings. In most cases, it changes proportionally to rising ICP, and observation of these changes may be clinically useful. We introduce the higher harmonics centroid (HHC) which can be defined as the center of mass of harmonics of the ICP pulse waveform from the 2nd to 10th, where mass corresponds to amplitudes of these harmonics. We investigate the changes in HHC during ICP monitoring, including isolated episodes of ICP plateau waves. Recordings from 325 patients treated between 2002 and 2010 were reviewed. Twenty-six patients with ICP plateau waves were identified. In the first step, the correlation between HHC and ICP was examined for the entire monitoring period. In the second step, the above relation was calculated separately for periods of elevated ICP during plateau wave and the baseline. For the values averaged over the whole monitoring period, ICP (22.3 ± 6.9 mm Hg) correlates significantly (R = 0.45, p = 0.022) with HHC (3.64 ± 0.46). During the ICP plateau waves (ICP increased from 20.9 ± 6.0 to 53.7 ± 9.7 mm Hg, p < 10 The good correlation between HHC and ICP supports the clinical application of pressure waveform analysis in addition to the recording of ICP number only. Mean ICP may be distorted by a zero drift, but HHC remains immune to this error. Further research is required to test whether a decline in HHC with elevated ICP can be an early warning sign of intracranial hypertension, whether individual breakpoints of correlation between ICP and its centroid are of clinical importance.
Sections du résumé
BACKGROUND
The pulse waveform of intracranial pressure (ICP) is its distinctive feature almost always present in the clinical recordings. In most cases, it changes proportionally to rising ICP, and observation of these changes may be clinically useful. We introduce the higher harmonics centroid (HHC) which can be defined as the center of mass of harmonics of the ICP pulse waveform from the 2nd to 10th, where mass corresponds to amplitudes of these harmonics. We investigate the changes in HHC during ICP monitoring, including isolated episodes of ICP plateau waves.
MATERIAL AND METHODS
Recordings from 325 patients treated between 2002 and 2010 were reviewed. Twenty-six patients with ICP plateau waves were identified. In the first step, the correlation between HHC and ICP was examined for the entire monitoring period. In the second step, the above relation was calculated separately for periods of elevated ICP during plateau wave and the baseline.
RESULTS
For the values averaged over the whole monitoring period, ICP (22.3 ± 6.9 mm Hg) correlates significantly (R = 0.45, p = 0.022) with HHC (3.64 ± 0.46). During the ICP plateau waves (ICP increased from 20.9 ± 6.0 to 53.7 ± 9.7 mm Hg, p < 10
CONCLUSIONS
The good correlation between HHC and ICP supports the clinical application of pressure waveform analysis in addition to the recording of ICP number only. Mean ICP may be distorted by a zero drift, but HHC remains immune to this error. Further research is required to test whether a decline in HHC with elevated ICP can be an early warning sign of intracranial hypertension, whether individual breakpoints of correlation between ICP and its centroid are of clinical importance.
Identifiants
pubmed: 34387744
doi: 10.1007/s00701-021-04958-1
pii: 10.1007/s00701-021-04958-1
pmc: PMC8599247
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3249-3258Informations de copyright
© 2021. The Author(s).
Références
Adolph RJ, Fukusumi H, Fowler N (1967) Origin of cerebrospinal fluid pulsations. Am J Physiol Leg Content 212:840–846
doi: 10.1152/ajplegacy.1967.212.4.840
Alperin NJ, Lee SH, Loth F, Raksin PB, Lichtor T (2000) MR-Intracranial pressure (ICP): a method to measure intracranial elastance and pressure noninvasively by means of MR imaging: baboon and human study. Radiology 217:877–885
doi: 10.1148/radiology.217.3.r00dc42877
Avezaat CJ, van Eijndhoven JH, Wyper DJ (1979) Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psychiatry 42:687–700. https://doi.org/10.1136/jnnp.42.8.687
doi: 10.1136/jnnp.42.8.687
pubmed: 490174
pmcid: 490301
Balédent O, Fin L, Khuoy L, Ambarki K, Gauvin AC, Gondry-Jouet C, Meyer ME (2006) Brain hydrodynamics study by phase-contrast magnetic resonance imaging and transcranial color doppler. J Magn Reson Imaging 24:995–1004
doi: 10.1002/jmri.20722
Berdyga J, Czosnyka M, Czernicki Z, Williamson M (1993) Analysis of the intracranial pressure waveform by means of spectral methods. In: Intracranial pressure VIII. Springer, Berlin, Heidelberg, pp 372–375
Bland JM, Altman DG (1995) Statistics notes: calculating correlation coefficients with repeated observations: Part 1—correlation within subjects. BMJ 310:446
doi: 10.1136/bmj.310.6977.446
Bray R, Sherwood A, Halter J, Robertson C, Grossman R (1986) Development of a clinical monitoring system by means of ICP waveform analysis. In: Intracranial pressure VI. Springer, Berlin, Heidelberg, pp 260–264
Cardoso ER, Rowan JO, Galbraith S (1983) Analysis of the cerebrospinal fluid pulse wave in intracranial pressure. J Neurosurg 59:817–821. https://doi.org/10.3171/jns.1983.59.5.0817
doi: 10.3171/jns.1983.59.5.0817
pubmed: 6619934
Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N (2017) Guidelines for the management of severe traumatic brain injury. Neurosurgery 80:6–15
doi: 10.1227/NEU.0000000000001432
Carrera E, Kim D-J, Castellani G, Zweifel C, Czosnyka Z, Kasprowicz M, Smielewski P, Pickard JD, Czosnyka M (2010) What shapes pulse amplitude of intracranial pressure? J Neurotrauma 27:317–324
doi: 10.1089/neu.2009.0951
Chopp M, Portnoy HD (1980) Systems analysis of intracranial pressure: comparison with volume-pressure test and CSF-pulse amplitude analysis. J Neurosurg 53:516–527
doi: 10.3171/jns.1980.53.4.0516
Christensen L, Børgesen SE (1989) Single pulse pressure wave analysis by fast Fourier transformation. Neurol Res 11:197–200
doi: 10.1080/01616412.1989.11739892
Contant CF Jr, Robertson CS, Crouch J, Gopinath SP, Narayan RK, Grossman RG (1995) Intracranial pressure waveform indices in transient and refractory intracranial hypertension. J Neurosci Methods 57:15–25
doi: 10.1016/0165-0270(94)00106-Q
Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD (1997) Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery 41:11–19
doi: 10.1097/00006123-199707000-00005
Czosnyka M, Smielewski P, Piechnik S, Schmidt EA, Al-Rawi PG, Kirkpatrick PJ, Pickard JD (1999) Hemodynamic characterization of intracranial pressure plateau waves in head-injured patients. J Neurosurg 91:11–19
doi: 10.3171/jns.1999.91.1.0011
Dias C, Maia I, Cerejo A, Varsos G, Smielewski P, Paiva J-A, Czosnyka M (2014) Pressures, flow, and brain oxygenation during plateau waves of intracranial pressure. Neurocrit Care 21:124–132
doi: 10.1007/s12028-013-9918-y
Donnelly J, Czosnyka M, Adams H, Cardim D, Kolias AG, Zeiler FA, Lavinio A, Aries M, Robba C, Smielewski P (2019) Twenty-five years of intracranial pressure monitoring after severe traumatic brain injury: a retrospective, single-center analysis. Neurosurgery 85:E75–E82
doi: 10.1093/neuros/nyy468
Dunbar HS, Guthrie TC, Karpell B (1966) A study of the cerebrospinal fluid pulse wave. Arch Neurol 14:624–630. https://doi.org/10.1001/archneur.1966.00470120056009
doi: 10.1001/archneur.1966.00470120056009
pubmed: 5935957
Fuentes J, Bouscarel C, Choucair Y, Roquefeuil B, Vlahovitch B, Blanchet P (1979) Monitoring of intracranial pression in acute neurotrauma by extra-dural screw (author’s transl). Anesth Analg Reanim 36:429–433
Gega A, Utsumi S, Iida Y, Iida N, Tsuncda S (1980) Analysis of the wave pattern of CSF pulse wave. In: Intracranial pressure IV. Springer, Berlin, Heidelberg, pp 188–190
Germon K (1988) Interpretation of ICP pulse waves to determine intracerebral compliance. The Journal of neuroscience nursing: journal of the American Association of Neuroscience Nurses 20:344–351
doi: 10.1097/01376517-198812000-00004
Gokaslan Z, Bray R, Sherwood A, Robertson C, Narayan R, Contant C, Grossman R (1989) Dynamic pressure volume index via ICP waveform analysis. In: Intracranial pressure VII. Springer, Berlin, Heidelberg, pp 124–128
Hamer J, Kühner A (1976) Mean intracranial resting pressure, episodic pressure fluctuations, and intracranial volume/pressure response in patients with subarachnoid hemorrhage. In: Intracranial pressure III. Springer, Berlin, Heidelberg, pp 157–161
Hawryluk GW, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G (2019) A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med 45:1783–1794
doi: 10.1007/s00134-019-05805-9
Hirai O, Handa H, Ishikawa M, Kim SH (1984) Epidural pulse waveform as an indicator of intracranial pressure dynamics. Surg Neurol 21:67–74
doi: 10.1016/0090-3019(84)90404-X
Lang EW, Paulat K, Witte C, Zolondz J, Mehdorn HM (2003) Noninvasive intracranial compliance monitoring: technical note and clinical results. J Neurosurg 98:214–218
doi: 10.3171/jns.2003.98.1.0214
Lin E, Poon W, Hutchinson R, Oh T (1991) Systems analysis applied to intracranial pressure waveforms and correlation with clinical status in head injured patients. Br J Anaesth 66:476–482
doi: 10.1093/bja/66.4.476
Morgalla MH, Stumm F, Hesse G (1999) A computer-based method for continuous single pulse analysis of intracranial pressure waves. J Neurol Sci 168:90–95. https://doi.org/10.1016/s0022-510x(99)00137-9
doi: 10.1016/s0022-510x(99)00137-9
pubmed: 10526189
Nornes H, Aaslid R, Lindegaard KF (1977) Intracranial pulse pressure dynamics in patients with intracranial hypertension. Acta Neurochir (Wien) 38:177–186. https://doi.org/10.1007/BF01401089
doi: 10.1007/BF01401089
Piper IR, Miller JD, Whittle IR, Lawson A (1990) Automated time-averaged analysis of craniospinal compliance (short pulse response). Acta Neurochir Suppl (Wien) 51:387–390. https://doi.org/10.1007/978-3-7091-9115-6_130
doi: 10.1007/978-3-7091-9115-6_130
Robertson CS, Narayan RK, Contant CF, Grossman RG, Gokaslan ZL, Pahwa R, Caram P, Bray RS, Sherwood AM (1989) Clinical experience with a continuous monitor of intracranial compliance. J Neurosurg 71:673–680
doi: 10.3171/jns.1989.71.5.0673
Rosner MJ, Becker DP (1984) Origin and evolution of plateau waves: experimental observations and a theoretical model. J Neurosurg 60:312–324
doi: 10.3171/jns.1984.60.2.0312
Shapiro K, Marmarou A (1982) Clinical applications of the pressure-volume index in treatment of pediatric head injuries. J Neurosurg 56:819–825. https://doi.org/10.3171/jns.1982.56.6.0819
doi: 10.3171/jns.1982.56.6.0819
pubmed: 7077382
Sullivan HG, Miller JD, Becker DP, Flora RE, Allen GA (1977) The physiological basis of intracranial pressure change with progressive epidural brain compression. An experimental evaluation in cats. J Neurosurg 47:532–550. https://doi.org/10.3171/jns.1977.47.4.0532
doi: 10.3171/jns.1977.47.4.0532
pubmed: 903806
Takizawa H, Gabra-Sanders T, Miller DJ (1987) Changes in the cerebrospinal fluid pulse wave spectrum associated with raised intracranial pressure. Neurosurgery 20:355–361
doi: 10.1227/00006123-198703000-00001
Unnerbäck M, Ottesen JT, Reinstrup P (2018) ICP curve morphology and intracranial flow-volume changes: a simultaneous ICP and cine phase contrast MRI study in humans. Acta Neurochir 160:219–224
doi: 10.1007/s00701-017-3435-2
Varsos GV, De Riva N, Smielewski P, Pickard JD, Brady KM, Reinhard M, Avolio A, Czosnyka M (2013) Critical closing pressure during intracranial pressure plateau waves. Neurocrit Care 18:341–348
doi: 10.1007/s12028-013-9830-5
Zou R, Park E-H, Kelly EM, Egnor M, Wagshul ME, Madsen JR (2008) Intracranial pressure waves: characterization of a pulsation absorber with notch filter properties using systems analysis. J Neurosurg Pediatr 2:83–94
doi: 10.3171/PED/2008/2/7/083