Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2018
Visualizing Cerebrovascular Autoregulation Insults and Their Association with Outcome in Adult and Paediatric Traumatic Brain Injury.
The aim of this study is to assess visually the impact of duration and intensity of cerebrovascular autoregulation insults on 6-month neurological outcome in severe traumatic brain injury. ⋯ The colour-coded plots indicate that cerebrovascular autoregulation is disturbed in a dynamic manner, such that duration and intensity play a role in the determination of a zone associated with better neurological outcome.
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Acta Neurochir. Suppl. · Jan 2018
Medical Waveform Format Encoding Rules Representation of Neurointensive Care Waveform Data.
Technology in neurointensive care units can collect and store vast amounts of complex patient data. The CHART-ADAPT project is aimed at developing technology that will allow for the collection, analysis and use of these big data at the patient's bedside in neurointensive care units. A requirement of this project is to automatically extract and transfer high-frequency waveform data (e.g. ICP) from monitoring equipment to high performance computing infrastructure for analysis. Currently, no agreed data standard exists in neurointensive care for the description of this type of data. In this pilot study, we investigated the use of Medical Waveform Format Encoding Rules (MFER- www.mfer.org-ISO 11073-92001) as a possible data standard for neurointensive care waveform data. ⋯ The MFER waveform format has potential as a lightweight standard for representing high-frequency neurointensive care waveform data. Further work will include a comparison with other waveform data formats and a live trial of using the MFER waveform format to stream patient data over a longer period.
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Acta Neurochir. Suppl. · Jan 2018
Effect of Mild Hypocapnia on Critical Closing Pressure and Other Mechanoelastic Parameters of the Cerebrospinal System.
Brain arterial critical closing pressure (CrCP) has been studied in several diseases such as traumatic brain injury (TBI), subarachnoid haemorrhage, hydrocephalus, and in various physiological scenarios: intracranial hypertension, decreased cerebral perfusion pressure, hypercapnia, etc. Little or nothing so far has been demonstrated to characterise change in CrCP during mild hypocapnia. ⋯ During hypocapnia in TBI patients, ICP decreases and WT increases. CrCP increases slightly as the rise in wall tension outweighs the decrease in ICP. The closing margin remained unchanged, suggesting that the risk of hypocapnia-induced ischemia might not be increased.
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Following brain injury, unstable cerebral hemodynamics can be characterized by abnormal rises in intracranial pressure (ICP). This behavior has been quantified by the RAP index: the correlation (R) between ICP pulse amplitude (A) and mean (P). While RAP could be a valuable indicator of autoregulatory processes, its prognostic ability is not well established and its validity has been questioned due to potential errors in measurement. Here, we test (1) whether RAP is a consistent measure of intracranial hemodynamics and (2) whether RAP has prognostic value in predicting hemodynamic instability following brain injury. ⋯ We conclude that RAP can provide a valid measure of ICP dynamics, is not affected by sensor drift, and can better distinguish periods of instability than ICP or AMP alone.
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Acta Neurochir. Suppl. · Jan 2018
Comparative StudyComparison of Intracranial Pressure and Pressure Reactivity Index Obtained Through Pressure Measurements in the Ventricle and in the Parenchyma During and Outside Cerebrospinal Fluid Drainage Episodes in a Manipulation-Free Patient Setting.
We investigated the effect of cerebrospinal fluid (CSF) drainage on the intracranial pressure (ICP) signal measured in the parenchyma and the ventricle as well as the effect on the pressure reactivity index (PRx) calculated from both signals. ⋯ Drainage of CSF reduces ICP magnitude and amplitude through the EVD. This effect was only marginal in parenchymal ICP measurements. In manipulation-free circumstances, agreement of PRx obtained through parenchymal and ventricular measurements was moderate to good, depending on the statistical method, and was not necessarily influenced by drainage.