Key result
The pulsatile part of the intracranial pressure curve, when transformed into a volume curve, significantly correlated with the pulsatile part of cerebral blood flow measured by MRI (R2 = 0.688).
Why the study?
Does continuous intracranial pressure curve analysis correlate with the pulsatile component of cerebral blood flow in neurocritical care patients?
Observational (n=13)
Single-blind
No
Does continuous intracranial pressure curve analysis correlate with the pulsatile component of cerebral blood flow in neurocritical care patients?
Effect estimate: R2 0.688
p-value: p=<0.001
Mathematical transformation of the continuous intracranial pressure curve into a volume curve correlates significantly with the pulsatile component of cerebral blood flow, offering a potential bedside method for continuous CBF estimation.
May support bedside pulsatile CBF estimation from ICP curves in neurocritical care; leaves open prospective outcome validation.
Current methods to measure cerebral blood flow (CBF) in the neuro critical care setting cannot monitor the CBF continuously. In contrast, continuous measurement of intracranial pressure (ICP) is readily accomplished, and there is a component of ICP that correlates with arterial inflow of blood into the cranial cavity. This property may have utility in using continuous ICP curve analysis to continuously estimate CBF. We examined the data from 13 patients, monitored with an intraventricular ICP device determining the pulsatile amplitude ICPamp as well as the area under the ICP curve (AUCICP). Using an elastance measurement, the ICP curve was converted to craniospinal volume (AUCΔV). The patients were examined with Phase Contrast Magnetic Resonance Imaging (MRI), measuring flow in the carotid and vertebral arteries. This made it possible to calculate CBF for one cardiac cycle (ccCBFMRtot) and divide it into the pulsatile (ccCBFMRpuls) and non-pulsatile (ccCBFMRconst) flow. ICP derived data and MRI measurements were compared. Linear regression was used to establish wellness of fit and ANOVA was used to calculate the P value. No correlation was found between ICPamp and the ccICPMRpuls (P = 0.067). In contrast there was a correlation between the AUCICP and ccCBFMRpuls (R2 = 0.440 P = 0.013). The AUCΔV correlated more appropriately with the ccCBFMRpuls. (R2 = 0.688 P < 0.001). Our findings suggests that the pulsatile part of the intracranial pressure curve, especially when transformed into a volume curve, correlates to the pulsatile part of the CBF.
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Unnerbäck et al. (2018) conducted an observational in Neurocritical care patients requiring intracranial pressure monitoring (n=13). Intracranial pressure curve analysis (AUC ΔV) vs. Phase contrast MRI (ccCBFMRpuls) was evaluated on Correlation between area under the pulsatile change in volume (AUC ΔV) and pulsatile cerebral blood flow (ccCBFMRpuls) (R2 0.688, p=<0.001). The pulsatile part of the intracranial pressure curve, when transformed into a volume curve, significantly correlated with the pulsatile part of cerebral blood flow measured by MRI (R2 = 0.688).
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