Analysis of Intracranial Pressure

Abstract

The monitoring of intracranial pressure (ICP) is an important tool in medicine for its ability to portray the brain's compliance status. The bedside monitor displays the ICP waveform and intermittent mean values to guide physicians in the management of patients, particularly those having sustained a traumatic brain injury. Researchers in the fields of engineering and physics have investigated various mathematical analysis techniques applicable to the waveform in order to extract additional diagnostic and prognostic information, although they largely remain limited to research applications. The purpose of this review is to present the current techniques used to monitor and interpret ICP and explore the potential of using advanced mathematical techniques to provide information about system perturbations from states of homeostasis. We discuss the limits of each proposed technique and we propose that nonlinear analysis could be a reliable approach to describe ICP signals over time, with the fractal dimension as a potential predictive clinically meaningful biomarker. Our goal is to stimulate translational research that can move modern analysis of ICP using these techniques into widespread practical use, and to investigate to the clinical utility of a tool capable of simplifying multiple variables obtained from various sensors.

Baseline pressure errors (BPEs) extensively influence intracranial pressure scores: results of a prospective observational study

“…Even though ICP monitoring has attracted the interest of neuroscientists for decades, the role of BPEs has not been discussed even in recent reviews on ICP monitoring [8-10]. We see two possible reasons for why the issue of BPEs previously has received little attention.…”

Moderately Elevated Intracranial Pressure after Diffuse Traumatic Brain Injury is Associated with Exacerbated Neuronal Pathology and Behavioral Morbidity in the Rat

“…10,11 These approaches have proven to have limited success in overcoming the predisposition for negative outcomes associated with elevated ICP after TBI 45,46 sparking debate over the efficacy of such ICP/CPP strategies and the cost benefit of invasive ICP monitoring. [13][14][15]30,[47][48][49] The current study, however, suggests that global ischemia is not the only threat of elevated ICP contributing to morbidity after TBI and speaks to a need for additional basic research exploring the pathologies exacerbated by elevated ICP after TBI.…”

The correlation between pulsatile intracranial pressure and indices of intracranial pressure-volume reserve capacity: results from ventricular infusion testing

“…8,9 The ICP is characterized by the static ICP, which is the pressure difference between the intracranial compartment and atmospheric reference pressure, and the pulsatile ICP, which are pressure waves created by cardiac contractions. 2 Part of the reason for ICP monitoring is the desire to obtain information about the intracranial pressure-volume reserve capacity, which is defined by the intracranial elastance (ICE; change in pressure [dP]/change in volume [dV]).…”