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Pressures, Flow, and Brain Oxygenation During Plateau Waves of Intracranial Pressure

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Abstract

Background

Plateau waves are common in traumatic brain injury. They constitute abrupt increases of intracranial pressure (ICP) above 40 mmHg associated with a decrease in cerebral perfusion pressure (CPP). The aim of this study was to describe plateau waves characteristics with multimodal brain monitoring in head injured patients admitted in neurocritical care.

Methods

Prospective observational study in 18 multiple trauma patients with head injury admitted to Neurocritical Care Unit of Hospital Sao Joao in Porto. Multimodal systemic and brain monitoring of primary variables [heart rate, arterial blood pressure, ICP, CPP, pulse amplitude, end tidal CO2, brain temperature, brain tissue oxygenation pressure, cerebral oximetry (CO) with transcutaneous near-infrared spectroscopy and cerebral blood flow (CBF)] and secondary variables related to cerebral compensatory reserve and cerebrovascular reactivity were supported by dedicated software ICM+ (www.neurosurg.cam.ac.uk/icmplus). The compiled data were analyzed in patients who developed plateau waves.

Results

In this study we identified 59 plateau waves that occurred in 44 % of the patients (8/18). During plateau waves CBF, cerebrovascular resistance, CO, and brain tissue oxygenation decreased. The duration and magnitude of plateau waves were greater in patients with working cerebrovascular reactivity. After the end of plateau wave, a hyperemic response was recorded in 64 % of cases with increase in CBF and brain oxygenation. The magnitude of hyperemia was associated with better autoregulation status and low oxygenation levels at baseline.

Conclusions

Multimodal brain monitoring facilitates identification and understanding of intrinsic vascular brain phenomenon, such as plateau waves, and may help the adequate management of acute head injury at bed side.

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Conflict of interest

The software for brain monitoring ICM+ (www.neurosurg.cam.ac.uk/imcplus) is licensed by the University of Cambridge (Cambridge Enterprise). Peter Smielewski and Marek Czosnyka have financial interests in a part of the licensing fee. All other authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Intensive Care Department, Neurocritical Care Unit, Hospital Sao Joao, Porto, Portugal

    Celeste Dias, Isabel Maia & José-Artur Paiva

  2. Neurosurgery Department, Hospital Sao Joao, Porto, Portugal

    António Cerejo

  3. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge, UK

    Georgios Varsos, Peter Smielewski & Marek Czosnyka

Authors
  1. Celeste Dias
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  2. Isabel Maia
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  3. António Cerejo
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  4. Georgios Varsos
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  5. Peter Smielewski
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  6. José-Artur Paiva
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  7. Marek Czosnyka
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Corresponding author

Correspondence to Celeste Dias.

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Dias, C., Maia, I., Cerejo, A. et al. Pressures, Flow, and Brain Oxygenation During Plateau Waves of Intracranial Pressure. Neurocrit Care 21, 124–132 (2014). https://doi.org/10.1007/s12028-013-9918-y

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  • DOI: https://doi.org/10.1007/s12028-013-9918-y

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