Abstract
The aim of this study was to describe multimodal brain monitoring characteristics during plateau waves of intracranial pressure (ICP) in patients with head injury, using ICM+ software for continuous recording. Plateau waves consist of an abrupt elevation of ICP above 40 mmHg for 5–20 min. This is a prospective observational study of patients with head injury who were admitted to a neurocritical care unit and who developed plateau waves. We analyzed 59 plateau waves that occurred in 8 of 18 patients (44 %). At the top of plateau waves arterial blood pressure remained almost constant, but cerebral perfusion pressure, cerebral blood flow, brain tissue oxygenation, and cerebral oximetry decreased. After plateau waves, patients with a previously better autoregulation status developed hyperemia, demonstrated by an increase in cerebral blood flow and brain oxygenation. Pressure and oxygen cerebrovascular reactivity indexes (pressure reactivity index and ORxshort) increased significantly during the plateau wave as a sign of disruption of autoregulation. Bedside multimodal brain monitoring is important to characterize increases in ICP and give differential diagnoses of plateau waves, as management of this phenomenon differs from that of regular ICP.
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Disclosure
The ICM+ software for brain monitoring (www.neurosurg.cam.ac.uk/imcplus) is licensed by the University of Cambridge (Cambridge Enterprise). Peter Smielewski and Marek Czosnyka have financial interests in part of the licensing fee. All other authors declare that they have no conflicts of interest.
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We declare that we have no conflict of interest.
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Dias, C., Maia, I., Cerejo, A., Smielewski, P., Paiva, JA., Czosnyka, M. (2016). Plateau Waves of Intracranial Pressure and Multimodal Brain Monitoring. In: Ang, BT. (eds) Intracranial Pressure and Brain Monitoring XV. Acta Neurochirurgica Supplement, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-22533-3_29
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DOI: https://doi.org/10.1007/978-3-319-22533-3_29
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