Critical Closing Pressure During a Controlled Increase in Intracranial Pressure

Katarzyna Kaczmarska , Magdalena Kasprowicz , Antoni Grzanka , Wojciech Zabołotny , Peter Smielewski , Despina Afroditi Lalou , Georgios V Varsos , Marek Czosnyka , Z Czosnyka


Objectives: The objectives were to compare three methods of estimating critical closing pressure (CrCP) in a scenario of a controlled increase in intracranial pressure (ICP) induced during an infusion test in patients with suspected normal pressure hydrocephalus (NPH). Methods: We retrospectively analyzed data from 37 NPH patients who underwent infusion tests. Computer recordings of directly measured intracranial pressure (ICP), arterial blood pressure (ABP) and transcranial Doppler cerebral blood flow velocity (CBFV) were used. The CrCP was calculated using three methods: first harmonics ratio of the pulse waveforms of ABP and CBFV (CrCPA) and two methods based on a model of cerebrovascular impedance, as a function of cerebral perfusion pressure (CrCPinv), and as a function of ABP (CrCPninv). Results: There is good agreement among the three methods of CrCP calculation, with correlation coefficients being greater than 0.8 (p < 0.0001). For the CrCPA method, negative values were found for about 20% of all results. Negative values of CrCP were not observed in estimators based on cerebrovascular impedance. During the controlled rise of ICP, all three estimators of CrCP increased significantly (p < 0.05). The strongest correlation between ICP and CrCP was found for CrCPinv (median R = 0.41). Conclusion: Invasive CrCP is most sensitive to variations in ICP and can be used as an indicator of the status of the cerebrovascular system during infusion tests.
Author Katarzyna Kaczmarska (FEIT / PE)
Katarzyna Kaczmarska,,
- The Institute of Electronic Systems
, Magdalena Kasprowicz - [Wrocław University of Science and Technology]
Magdalena Kasprowicz,,
, Antoni Grzanka - [Warsaw University of Technology (PW)]
Antoni Grzanka,,
- Politechnika Warszawska
, Wojciech Zabołotny (FEIT / PE)
Wojciech Zabołotny,,
- The Institute of Electronic Systems
, Peter Smielewski - [University of Cambridge]
Peter Smielewski,,
, Despina Afroditi Lalou - [University of Cambridge]
Despina Afroditi Lalou,,
, Georgios V Varsos - [University of Cambridge]
Georgios V Varsos,,
, Marek Czosnyka (FEIT / PE)
Marek Czosnyka,,
- The Institute of Electronic Systems
, Z Czosnyka - [University of Cambridge]
Z Czosnyka,,
Publication size in sheets0.5
Book Heldt Thomas (eds.): Intracranial Pressure & Neuromonitoring XVI, Acta Neurochirurgica Supplement, vol. 126, 2018, Cham, Springer International Publishing, ISBN 978-3-319-65797-4, [978-3-319-65798-1], DOI:10.1007/978-3-319-65798-1
Keywords in EnglishCritical closing pressure · Wall tension Intracranial pressure · Cerebral autoregulation · Infusion test
Languageen angielski
kk-acta-neurochir-supp.pdf 473.02 KB
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