Changes in intracranial pressure and pulse wave amplitude during postural shifts
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ORIGINAL ARTICLE -CSF CIRCULATION
Changes in intracranial pressure and pulse wave amplitude during postural shifts Nicolas Hernandez Norager 1,2
&
Markus Harboe Olsen 3 & Casper Schwartz Riedel 1,4 & Marianne Juhler 1,5,6
Received: 2 May 2020 / Accepted: 24 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Monitoring of intracranial pressure (ICP) and ICP pulse wave amplitude (PWA) is an integrated part of neurosurgery. An increase in ICP usually leads to an increase in PWA. These findings have yet to be replicated during the positional shift from supine to upright, where we only know that ICP decreases. Our main aim is to clarify whether the positional shift also results in a change in pulse wave amplitude. Method Our database was retrospectively reviewed for subjects having had a standardized investigation of positional ICP. In all subjects, mean ICP and PWA were determined with both an automatic and a manual method and compared using Student’s t test. Finally, ICP and PWA were tested for correlation in both in supine and upright position. Results The study included 29 subjects. A significant change in ICP (Δ14.1 mmHg, p < 0.01) and no significant change in PWA (Δ0.4 mmHg, p = 0.06) were found. Furthermore, a linear correlation between ICP and PWA was found in both supine and upright positions (p < 0.01). Conclusions We found that during the positional shift from supine to upright, ICP is reduced while PWA remains unaffected. This indicates that the pressure-volume curve is shifted downward according to a hydrostatic pressure offset, while the slope of the curve does not change. In addition, the correlation between ICP and PWA in both supine and upright position validates the previous research on the matter. Keywords ICP . Intracranial physiology . Intracranial pressure . Intracranial pressure pulse wave . PWA . Pulse wave amplitude
Introduction Monitoring of intracranial pressure (ICP) and intracranial pressure pulse wave amplitude (PWA) is an integrated part of neurosurgery [8, 18]. In essence, PWA represents the This article is part of the Topical Collection on CSF Circulation * Nicolas Hernandez Norager
1
Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
2
Copenhagen, Denmark
3
Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen, Denmark
4
Department of Neurophysiology, Rigshospitalet, Glostrup, Denmark
5
Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
6
Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
cardiac pulse propagating through the intracranial compartment—i.e., an influx of arterial blood into the brain and mechanical distension of arteries spreading from the heart [6]. According to the volume-pressure relationship, the relative effect of a cardiac pulse on ICP will increase if ICP increases. Consequently, an increase in ICP usually results in a corresponding increase in PWA (Fig. 1) [15, 19, 22, 25]. This relationship both makes theoretical sense and is experime
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