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  • 1
    Electronic Resource
    Electronic Resource
    Validation of a tonometric noninvasive arterial blood pressure monitor in the intensive care setting (2003)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 58 (2003), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary Intra-arterial measurement is considered the gold standard for continuous, beat-to-beat arterial blood pressure monitoring. However, arterial cannulation can be difficult and may cause complications such as thrombosis and ischaemia. Recently, a tonometric system, the Colin CBM-7000 has been developed for noninvasive beat-to-beat measurement of arterial blood pressure from the radial artery. We assessed the level of agreement between the CBM-7000 and invasive radial artery measurements in 15 patients on a neuro-intensive care unit. Agreement of systolic, diastolic and mean arterial pressure values was limited, with ≈ 34% of mean arterial pressures differing by over 10 mmHg. In many cases, this was due to a downward drift of the noninvasive measurements over time. Furthermore, there was a tendency to underestimate low pressures and overestimate high pressures. In our opinion, the Colin CBM-7000 cannot be recommended for continuous blood pressure monitoring in the intensive care setting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2003.03122.x
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  • 2
    Electronic Resource
    Electronic Resource
    Cerebrospinal compensation in hydrocephalic children (1993)
    Springer
    Child's nervous system 9 (1993), S. 17-22 
    Details
    ISSN: 1433-0350
    Keywords: Hydrocephalus ; Cerebrospinal fluid pressure ; Cerebrospinal compensation ; Infusion test
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract One hundred and fifteen cases of hydrocephalus in children were analysed. Cerebrospinal compensatory reserve was assessed by a computerized, constant rate, lumbar infusion test. Head circumference and ventricular size were measured and a psychometric examination carried out. A classification of hydrocephalus based on resting cerebrospinal fluid pressure (CSFP) and resistance to cerebrospinal fluid outflow (RCSF) was introduced. Parameters of compensatory reserve were compared in atrophy (low CSFP, low RCSF), normal-pressure hydrocephalus (low CSFP, increased RCSF), non-communicating hydrocephalus (high CSFP, low RCSF) and acute hydrocephalus (high CSFP and increased RCSF). Significant differences were found between the factors describing compensatory ability in these groups. Sixty-two patients could be classified on the basis of resting CSFR and RCSF. Differentiation between the types of hydrocephalus was shown to be more accurate when all variables measured during the pressure-volume test were considered. The patterns of the time courses of CSFP during rate infusion tests in the different types of hydrocephalus are presented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00301929
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  • 3
    Electronic Resource
    Electronic Resource
    The role of cerebrospinal compensatory parameters in the estimation of functioning of implanted shunt system in patients with communicating hydrocephalus (preliminary report) (1989)
    Springer
    Acta neurochirurgica 101 (1989), S. 112-116 
    Details
    ISSN: 0942-0940
    Keywords: Communicating hydrocephalus ; intracranial pressure ; shunt implantation ; resistance to CSF outflow ; CSF formation rate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twelve patients presenting with communicating hydrocephalus were studied. In 9 cases where the mean ICP level remained below 10mmHg the symptoms of normal pressure hydrocephalus were observed. All of the patients were treated by shunt system implantation. The clinical and psychological state, cranial computerized tomography and parameters of the cerebrospinal compensatory mechanisms, evaluated using the constant rate infusion test were compared before and after treatment. In most of the patients (11) the pathologically enlarged ventricles persisted. Only in three cases no clinical improvement was noticed. In this group the resistance to the cerebrospinal fluid absorption and the fluid formation rate were estimated as normal. In the group with improvement the normalization of the resistance (4), decrease in the cerebrospinal fluid formation rate (4) and decrease in the cerebrospinal system elasticity (1) can be pointed out as factors responsible for improvement manifested after shunting. Therefore the resorption resistance and the formation of cerebrospinal fluid should be considered as predictive factors in the shunt implantation in hydrocephalic patients, and play an important role in the diagnosis of this entity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01410524
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  • 4
    Electronic Resource
    Electronic Resource
    Significance of intracranial pressure waveform analysis after head injury (1996)
    Springer
    Acta neurochirurgica 138 (1996), S. 531-542 
    Details
    ISSN: 0942-0940
    Keywords: Head injury ; intracranial pressure ; monitoring ; outcome ; waveform analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors have investigated the relationships between the amplitude of the ICP pulse wave, the mean values of ICP and CPP, and the outcome of 56 head injured ventilated patients. The ICP was monitored continuously using a Camino transducer (35 patients) or subdural catheter (21 patients). The mean Glasgow Coma Score was 6 (range 3–13; 5 patients had a GCS 〉 8 after resuscitation). Patients were grouped according to their Glasgow Outcome Score assessed at 12 months after injury. The amplitude of ICP pulse waveform was assessed using the fundamental harmonic of the pulse waveform (AMP) to avoid distortion caused by different frequency responses of the pressure transducers used in the study. Statistical analysis revealed that in patients with fatal outcome the ICP pulse amplitude increased when the mean ICP increased to 25 mmHg and then began to decrease. The upper breakpoint of the AMP-ICP relationship was not present in patients with good/moderate outcome. The moving correlation coefficient between the fundamental harmonic of ICP pulse wave and the mean ICP (RAP: R-symbol of correlation between A-amplitude and P-pressure) was introduced to describe the time-dependent changes in correlation between amplitude and mean ICP. The RAP was significantly lower in patients who died or remained in the vegetative state. In 7 patients who died from uncontrollable intracranial hypertension RAP was oscillating or decreased to 0 or negative values well before brain-stem herniation. The combination of an ICP above 20 mmHg for a period longer than 6 hours with low correlation between the amplitude and pressure (RAP 〈 0.5) was described as an predictive index of an unfavourable outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411173
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  • 5
    Electronic Resource
    Electronic Resource
    Changes in transcranial Doppler flow velocity waveform following inhibition of nitric oxide synthesis (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 63-70 
    Details
    ISSN: 0942-0940
    Keywords: Transcranial Doppler ; cerebrocortical microcirculation ; basilar artery ; nitric oxide ; rabbits
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background Analysis of the transcranial Doppler blood flow velocity (FV) waveform is used clinically to detect changes in cerebral haemodynamic profile. Such changes may be initiated both by alterations in microvascular resistance and in the tone of the cerebral arteries. Methods The role of endothelial mechanisms was investigated using inhibition of NO synthesis by systemic administration of NG-nitro-L-arginine methyl ester (L-NAME, 6 mg/kg) followed by simultaneous monitoring of both basilar artery FV and cerebrocortical microcirculation (laser Doppler flowmetry, LDF) in aneasthetised, ventilated rabbits over 60 minutes. Results Arterial blood pressure (AP) increased significantly (p 〈 0.01) above baseline level in the second minute following L-NAME and remained elevated until the end of experiment. Time average mean and systolic FV decreased immediately following L-NAME injection, with the statistically significant (p 〈 0.01) decrease from the third minute. Diastolic FV did not show such radical changes. LDF exhibited a slow decrease with time becoming significantly lower than baseline (p 〈 0.01) at 50 min. Conclusion A gradual decrease in cortical microcirculation preceded by a rapid reaction recorded in the TCD waveform implies that an increase in the tone of the great cerebral arteries is the predominant phenomenon seen during the acute phase of NO synthase inhibition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01850870
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  • 6
    Electronic Resource
    Electronic Resource
    Computerized infusion test compared to steady pressure constant infusion test in measurement of resistance to CSF outflow (1992)
    Springer
    Acta neurochirurgica 119 (1992), S. 12-16 
    Details
    ISSN: 0942-0940
    Keywords: CSF dynamics ; resistence to CSF outflows ; CSF infusion test ; computerized analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Resistance to cerebro-spinal fluid outflow is together with intracranial pressure the most important parameter in the investigation of patients with disturbances of CSF dynamics. The methods for determination of resistance are either unreliable or too time-consuming for routine clinical use, which has limited the popularity of this kind of measurement. In this paper a method for computerized acquisition and processing of an infusion test is described. A good correlation to a standard technique is documented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01541775
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  • 7
    Electronic Resource
    Electronic Resource
    CO2 cerebrovascular reactivity as a function of perfusion pressure — a modelling study (1993)
    Springer
    Acta neurochirurgica 121 (1993), S. 159-165 
    Details
    ISSN: 0942-0940
    Keywords: Cerebral blood flow ; autoregulation ; cerebral perfusion pressure ; carbon dioxide ; computer modelling
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A mathematical model is described that demonstrated the properties of cerebral vascular resistance and compliance expressed as a function of cerebral perfusion pressure (CPP) and arterial CO2 partial pressure (PaCO2). The hypercapnic induced shift of the lower limit of autoregulation to a higher range of CPP, as shown by this model, is a useful characteristic that facilitates the differentiation between normal and impaired autoregulation described previously in experimental studies. Dynamic properties of cerebrovascular circulation derived from the relationship between pulse wave of CBF waveform and CPP have been analysed at different levels of PaCO2-phenomenon, being often described as dependence of blood flow velocity pulsatility index on the autoregulatory reserve. The model was also used to interpret interhemispheric asymmetry of CBF reactivity to changes in arterial concentration of CO2 in patients with carotid artery stenosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01809269
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  • 8
    Electronic Resource
    Electronic Resource
    Monitoring of cerebrospinal dynamics using continuous analysis of intracranial pressure and cerebral perfusion pressure in head injury (1994)
    Springer
    Acta neurochirurgica 126 (1994), S. 113-119 
    Details
    ISSN: 0942-0940
    Keywords: Cerebrospinal dynamics ; intracranial pressure ; cerebral perfusion pressure ; waveform analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Cerebrospinal dynamics has been investigated by statistical analysis of results of computerised monitoring of 80 head injured patients admitted to the Intensive Care Unit at Pinderfields General Hospital. One minute average values of intracranial pressure (ICP), systemic arterial pressure (ABP), cerebral perfusion pressure (CPP), amplitude of the fundamental component of the intracranial pressure pulse wave and the short-term moving correlation coefficient between that amplitude and mean ICP (RAP) were recorded. It was found that reduction of CPP down to 40mmHg was more often caused by decrease in ABP than increase in ICP. Further falls in CPP below 40mmHg were caused by substantial increases in ICP above 25 mmHg. The relationship between the ICP pulse wave amplitude and CPP showed a significant gradual increase in amplitude with CPP decreasing from 75 to 30 mmHg. For CPP below 30 mmHg there is a sharp decrease in amplitude followed by a change in the coefficient RAP from positive to negative values. This was interpreted as a sign of critical disturbance in cerebral circulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01476419
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  • 9
    Electronic Resource
    Electronic Resource
    Monitoring of Intracranial Compliance: Correction for a Change in Body Position (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 31-36 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Intracranial compliance; pressure-volume-index; constant term; body position.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  The objectives of our study were 1. to investigate whether the intracranial compliance changes with body position; 2. to test if the pressure-volume index (PVI) calculation is affected by different body positions; 3. to define the optimal parameter to correct PVI for changes in body position and 4. to investigate the physiological meaning of the constant term (P0) in the model of the intracranial volume-pressure relationship. Thirteen patients were included in this study. All patients were subjected to 2 to 3 different body positions. In each position, either classic bolus injection was performed for measurement of intracranial compliance and calculation of PVI or the new Spiegelberg compliance monitor was used to calculate PVI continuously. Four different models were used for calculating the constant pressure term P0 and the P0 corrected PVI values.  Pressure volume index not corrected for the constant term P0 significantly decreased with elevating the patients head (r=0.70, p〈0.0001). In contrast, volume-pressure response and ICP pulse amplitude did not change with position. Using the constant term P0 to correct the PVI we found no changes between the different body positions. Our results suggest that during the variation in body position there is no change in intracranial compliance but a change in hydrostatic offset pressure which causes a shifting of the volume-pressure curve along the pressure axis without its shape being affected. PVI measurements should either be performed only with the patient in the 0° recumbent position or that the PVI calculation should be corrected for the hydrostatic difference between the level of the ICP transducer and the hydrostatic indifference point of the craniospinal system close to the third thoracic vertebra.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050263
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  • 10
    Electronic Resource
    Electronic Resource
    A computer system for the identification of the cerebrospinal compensatory model (1990)
    Springer
    Acta neurochirurgica 105 (1990), S. 112-116 
    Details
    ISSN: 0942-0940
    Keywords: Cerebrospinal compensatory model ; computer system ; CSF infusion test ; intracranial pressure ; CSF resorption resistance ; pressure-volume index ; CSF formation rate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A computer system, based on IBM PC, was designed for the cerebrospinal compensatory model identification. The intracranial pressure (ICP) signal, registered during the lumbo-lumbar infusion test is analyzed by means of the spectral analysis algorithm in order to measure precisely the pulse wave amplitude. The amplitude and the mean ICP level, calculated repetetively within the period of about 8 seconds, are stored on the disk and form the basis for further model identification. Three different methods of identification were applied. They enable one to estimate the fundamental model parameters, such as: resistance to the cerebrospinal fluid resorption, pressure-volume index, baseline pressure, rate of formation of the cerebrospinal fluid. Statistical evaluation of the results of the infusion test analysis obtained by means of the system described in two groups of hydrocephalic patients (children and adults) is presented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01669992
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