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Low frequency pressure waves of possible autonomic origin in severely head-injured children

R A Minns1, P A Jones, I R Chambers

  • 1Child Life and Health, University of Edinburgh, 20 Sylvan Place, Edinburgh, EH9 1UW Scotland, UK. Robert.Minns@ed.ac.uk

Acta Neurochirurgica. Supplement
|April 25, 2009
PubMed

Insights

Previously unreported slow intracranial pressure (ICP) waveforms were detected in children with traumatic brain injury (TBI). These slow ICP waves may reflect heart rate and blood pressure variability in TBI patients.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Neurophysiology

Background:

  • Intracranial pressure (ICP) monitoring provides valuable clinical and pathophysiological data.
  • Information extracted includes mean ICP, cerebrovascular autoregulation, pulse pressure, and waveform abnormalities.
  • This study focuses on a specific slow frequency ICP waveform in pediatric traumatic brain injury (TBI).

Purpose of the Study:

  • To describe a slow frequency ICP waveform observed in children with TBI.
  • To investigate the potential pathophysiological basis of these waveforms.
  • To determine if these waveforms contain clinically useful information.

Main Methods:

  • Continuous ICP, Mean Arterial Pressure (MAP), Cerebral Perfusion Pressure (CPP), and heart rate (HR) data were collected from children with TBI.
  • A 10-year retrospective review of stored monitoring data was conducted.
  • Slow frequency waveforms were identified and analyzed.

Main Results:

  • Episodic slow pressure waves were found in 11 of 122 severely head-injured children.
  • These waveforms occurred in children aged 1.6-15 years and were in phase with MAP, CPP, and HR fluctuations.
  • The waves were not correlated with mean ICP, CPP, MAP, temperature, or autoregulation status.

Conclusions:

  • The identified slow ICP waveforms are previously unreported in pediatric TBI.
  • These waveforms may represent very low frequency (VLF) and ultra-low frequency (ULF) components of cardiovascular variability.
  • Further research is needed to understand their clinical significance.
Abstract

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