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Compensatory-Reserve-Weighted Intracranial Pressure and Its Association with Outcome After Traumatic Brain Injury.

L Calviello1, J Donnelly1, D Cardim1

  • 1Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.

Neurocritical Care
|October 19, 2017
PubMed
Summary

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A new metric, weighted intracranial pressure (ICP), shows promise in predicting mortality after traumatic brain injury (TBI). This weighted ICP better reflects changes associated with TBI mortality than standard mean ICP.

Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Biomedical Engineering

Background:

  • Traumatic brain injury (TBI) poses significant mortality risks.
  • Monitoring intracranial pressure (ICP) is crucial for managing TBI.
  • Standard mean ICP may not fully capture complex physiological changes leading to mortality.

Purpose of the Study:

  • To introduce and evaluate 'weightedICP' (compensatory-reserve-weighted intracranial pressure) as a novel variable for predicting TBI-related mortality.
  • To compare the predictive performance of weightedICP against standard mean ICP.

Main Methods:

  • ICP was prospectively monitored in 1023 sedated and ventilated TBI patients.
  • The RAP coefficient (correlation between ICP pulse amplitude and mean ICP) was calculated.
Keywords:
Brain traumaCompensatory reserveIntracranial pressureMortality

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  • WeightedICP was derived using the formula: ICP * (1 - RAP).

    • Main Results:

    • Both elevated ICP and weightedICP were associated with TBI mortality.
    • WeightedICP demonstrated higher test statistic values (K=93) compared to ICP (K=64) in outcome categorization.
    • Receiver operator curve analysis showed a non-statistically significant trend towards greater area under the curve for weightedICP (0.71) versus ICP (0.67).

    Conclusions:

    • WeightedICP is a significant predictor of mortality following head injury.
    • This new variable is sensitive to both rising absolute ICP and deteriorating pressure-volume compensation.
    • WeightedICP may offer a more comprehensive assessment of TBI severity and prognosis.