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A noninvasive estimation of cerebral perfusion pressure using critical closing pressure


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Publication Date: 2015-01-09

Journal Title: Journal of Neurosurgery

Publisher: American Association of Neurological Surgeons

Volume: 123

Issue: 3

Pages: 638-648

Language: English

Type: Article

Metadata: Show full item record

Citation: Varsos, G. V., Kolias, A. G., Smielewski, P., Brady, K. M., Varsos, V. G., Hutchinson, P. J., Pickard, J. D., & et al. (2015). A noninvasive estimation of cerebral perfusion pressure using critical closing pressure. Journal of Neurosurgery, 123 (3), 638-648.

Description: This is the author accepted manuscript. The final version is available from American Association of Neurological Surgeons via http://dx.doi.org/10.3171/2014.10.JNS14613.

Abstract: OBJECT Cerebral blood flow is associated with cerebral perfusion pressure (CPP), which is clinically monitored through arterial blood pressure (ABP) and invasive measurements of intracranial pressure (ICP). Based on critical closing pressure (CrCP), the authors introduce a novel method for a noninvasive estimator of CPP (eCPP). METHODS Data from 280 head-injured patients with ABP, ICP, and transcranial Doppler ultrasonography measurements were retrospectively examined. CrCP was calculated with a noninvasive version of the cerebrovascular impedance method. The eCPP was refined with a predictive regression model of CrCP-based estimation of ICP from known ICP using data from 232 patients, and validated with data from the remaining 48 patients. RESULTS Cohort analysis showed eCPP to be correlated with measured CPP (R = 0.851, p < 0.001), with a mean ± SD difference of 4.02 ± 6.01 mm Hg, and 83.3% of the cases with an estimation error below 10 mm Hg. eCPP accurately predicted low CPP (< 70 mm Hg) with an area under the curve of 0.913 (95% CI 0.883–0.944). When each recording session of a patient was assessed individually, eCPP could predict CPP with a 95% CI of the SD for estimating CPP between multiple recording sessions of 1.89–5.01 mm Hg. CONCLUSIONS Overall, CrCP-based eCPP was strongly correlated with invasive CPP, with sensitivity and specificity for detection of low CPP that show promise for clinical use.

Keywords: cerebral perfusion pressure, critical closing pressure, noninvasive model, transcranial Doppler ultrasonography, vascular disorders

Sponsorship: G. Varsos is supported by an A. G. Leventis Foundation Scholarship and a Charter Studentship from St. Edmund’s College, Cambridge. Dr. Kolias is supported by a Royal College of Surgeons of England Research Fellowship, a National Institute for Health Research (NIHR) Academic Clinical Fellowship, and a Raymond and Beverly Sackler Studentship. He also chairs the British Neurosurgical Trainee Research Collaborative, which has been supported with an educational grant from Codman. Dr. Hutchinson is supported by an NIHR Research Professorship, the NIHR Cambridge Biomedical Research Centre, and has been appointed as the Surgical Specialty Lead for Neurosurgery, Royal College of Surgeons of England Clinical Research Initiative. He is a director of Technicam, a manufacturer of cranial access devices for neuromonitoring. He has also received honoraria from Codman. J. Pickard’s research (excluding salary) is supported by the NIHR Cambridge Biomedical Research Centre and an NIHR Senior Investigator Award. ICM+ Software is licensed by Cambridge Enterprise, Cambridge, UK, and Dr. Czosnyka and Dr. Smielewski have a financial interest in a fraction of the licensing fee. Dr. Czosnyka has also served as a consultant to Codman.

Identifiers:

This record's URL: http://dx.doi.org/10.3171/2014.10.JNS14613http://www.repository.cam.ac.uk/handle/1810/247174





Author: Varsos, Georgios V.Kolias, Angelos G.Smielewski, PeterBrady, Ken M.Varsos, Vassilis G.Hutchinson, Peter J.Pickard, John D.Czosnyka

Source: https://www.repository.cam.ac.uk/handle/1810/247174



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