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Critical closing pressure during experimental intracranial hypertension: comparison of three calculation methods
Katarzyna Kaczmarska1,2, Agnieszka Uryga3, Michał M Placek3,4
1Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
Insights
The pulsatile flow forward (PFF) model is recommended for estimating critical closing pressure (CrCP) more accurately than Aaslid's formula. Both impedance methods showed limitations compared to PFF, especially at lower blood pressures.
Area of Science:
- Neuroscience
- Physiology
- Biomedical Engineering
Background:
- Critical closing pressure (CrCP) is vital for assessing cerebrovascular tone.
- Accurate CrCP estimation methods are lacking, hindering clinical application.
- Existing methods include Aaslid's formula and cerebrovascular impedance techniques.
Purpose of the Study:
- Compare three CrCP estimation methods: Aaslid's formula, continuous flow forward (CFF), and pulsatile flow forward (PFF).
- Evaluate method accuracy under varying physiological conditions (intracranial hypertension, hypotension, hypocapnia, hypercapnia).
Main Methods:
- Retrospective experimental study in New Zealand white rabbits.
- Physiological maneuvers included induced intracranial hypertension, sympathetic blockade, and respiratory modulation.
- CrCP estimation using Aaslid's formula, CFF, and PFF models.
Main Results:
- All CrCP estimates increased with intracranial hypertension and hypocapnia.
- Hypercapnia decreased CrCP estimates, with Aaslid's formula yielding non-physiological values in 16% of cases.
- Bland-Altman analysis showed agreement between methods deteriorated at lower estimated CrCP values.
Conclusions:
- Aaslid's formula has limited clinical utility for CrCP calculation.
- The pulsatile flow forward (PFF) model provides a more accurate hemodynamic description and is recommended for CrCP estimation.
- Cerebrovascular impedance methods, particularly PFF, offer improved accuracy over conventional formulas.
Abstract:
Objectives: The critical closing pressure (CrCP) defines arterial blood pressure below which cerebral arteries collapse. It represents a clinically relevant parameter for the estimation of cerebrovascular tone. Although there are few methods to assess CrCP, there is no consensus which of them estimates this parameter most accurately. The aim of present retrospective, experimental study was to compare three methods of CrCP estimation: conventional Aaslid's formula and methods based on the cerebrovascular impedance: the established continuous flow forward (CFF) and a new pulsatile flow forward (PFF) model.Methods: The effects of the following physiological manoeuvres on the CrCP were studied in New Zealand white rabbits: lumbar infusion of Hartmann's solution to induce mild intracranial hypertension, sympathetic blockade to induce arterial hypotension, and modulation of respiratory tidal volume to induce hypocapnia or hypercapnia.Results: During intracranial hypertension, all CrCP estimates were significantly higher than at baseline, decreased with decreasing ABP and increased with gradual hypocapnia. During hypercapnia, all CrCP estimates were significantly decreased but only in the case of CrCPA the negative, non-physiological values were observed (16% of the cases). The Bland-Altman analysis revealed that a good agreement between each impedance method and Aaslid's method deteriorated significantly in the low range of the average numerical value of the estimates.Discussion: Our results confirm the limited usage of Aaslid's formula for the calculation of CrCP. Although both impedance methods seem to be equivalent, the fact that PFF model better describes cerebrovascular hemodynamic allows the recommendation of this model for the calculation of CrCP.
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