Key result
Direct and derived intracranial pressure measures, including Fourier analysis of arterial blood pressure and intracranial pressure, correlated with patient outcomes in 5 critically ill patients.
Why the study?
Does complex waveform analysis of intracranial pressure and arterial blood pressure during rest and suctioning correlate with patient outcomes in critically ill neurological patients?
Observational (n=5)
Does complex waveform analysis of intracranial pressure and arterial blood pressure during rest and suctioning correlate with patient outcomes in critically ill neurological patients?
Complex waveform analysis of arterial blood pressure and intracranial pressure during single cardiac and respiratory cycles may provide relevant information on cerebral compliance and patient outcomes.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating in a 5-patient feasibility cohort; larger prospective studies needed before clinical consideration of waveform-derived ICP measures.
Cerebral compliance is a measure of cerebral adaptability to increases in volume within the intracranial space and an indicator of risk for neurological deterioration. However, no direct measurement of compliance exists in clinical practice to guide nursing care or treatment decisions. Current use of mean intracranial pressure (MICP) and gross morphological intracranial pressure waveform (ICPW) analysis have great variability in predicting outcomes. The purpose of this review and pilot study was to evaluate the effects of suctioning on MICP and other measures estimating cerebral compliance derived from analysis of ICPW on patient outcome. We analyzed arterial blood pressure waveforms (ABPWs), ICPWs, and respiratory cycle variations using Fourier Transform analysis, to explore the potential benefits of studying ICPWs across single cardiac and respiratory cycles using linear modeling and calculation of correlation coefficients. ABPWs, ICPWs, and MICP were measured over individual cardiac cycles across multiple respiratory phases in five critically ill neurological patients. Both direct and derived ICP measures, including Fourier analysis of ABP and ICP and the cross-transform between ABP and ICP, were correlated with patient outcome. This more complex waveform analysis of individual ABPW and ICPW together, and derived measures during both single cardiac and respiratory cycles, may provide information relevant to cerebral compliance and patient outcomes. Pending confirmation with additional data sets, this technique may be a useful real-time clinical tool to provide a measure of compliance and risk of neurological deterioration for clinicians.
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Hickey et al. (2009) conducted an observational in Critically ill neurological patients (n=5). Suctioning vs. Rest was evaluated on Correlation of direct and derived intracranial pressure measures with patient outcome. Direct and derived intracranial pressure measures, including Fourier analysis of arterial blood pressure and intracranial pressure, correlated with patient outcomes in 5 critically ill patients.
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