Principles of cerebral hemodynamics when intracranial pressure is raised: lessons from the peripheral circulation

Journal of Hypertension
Mi Ok KimMarek Czosnyka

Abstract

The brain is highly vascular and richly perfused, and dependent on continuous flow for normal function. Although confined within the skull, pressure within the brain is usually less than 15 mmHg, and shows small pulsations related to arterial pulse under normal circumstances. Pulsatile arterial hemodynamics in the brain have been studied before, but are still inadequately understood, especially during changes of intracranial pressure (ICP) after head injury. In seeking cohesive explanations, we measured ICP and radial artery pressure (RAP) invasively with high-fidelity manometer systems, together with middle cerebral artery flow velocity (MCAFV) (transcranial Doppler) and central aortic pressure (CAP) generated from RAP, using a generalized transfer function technique, in eight young unconscious, ventilated adults following closed head trauma. We focused on vascular effects of spontaneous rises of ICP ('plateau waves'). A rise in mean ICP from 29 to 53 mmHg caused no consistent change in pressure outside the cranium, or in heart rate, but ICP pulsations increased in amplitude from 8 to 20 mmHg, and ICP waveform came to resemble that in the aorta. Cerebral perfusion pressure (=central aortic pressure - ICP), which equates with t...Continue Reading

References

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Jun 6, 2009·Physiological Measurement·Dong-Joo KimMarek Czosnyka
Jul 1, 2009·Neurocritical Care·Gianluca CastellaniMarek Czosnyka
Apr 17, 2010·American Journal of Hypertension·Roy L SoizaDavid J P Williams
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Aug 21, 2014·The New England Journal of Medicine·Michael R DeBaunJames F Casella

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Citations

Mar 24, 2016·American Journal of Hypertension·Michael F O'RourkeElazer R Edelman
Jul 18, 2018·American Journal of Hypertension·Michael F O'RourkeMichel E Safar
Mar 21, 2018·Current Hypertension Reports·Alberto AvolioMark Butlin
Dec 30, 2018·Journal of Nursing Measurement·Niyatee P SamudraDaiWai M Olson
Jul 19, 2019·BMC Cardiovascular Disorders·Arleen De León-RobertHeidy Merari Campusano-Castellanos

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Methods Mentioned

BETA
RAP

Software Mentioned

ICM
SphygmoCor

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