The relationship between the intracranial pressure–volume index and cerebral autoregulation
Objective The pressure–volume index (PVI) can be used to assess the cerebrospinal fluid dynamics and intracranial elastance in critically ill brain injured patients. The dependency of PVI on the state of cerebral autoregulation within the physiologic range of cerebral perfusion pressure (CPP) can be...
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| Veröffentlicht in: | Intensive care medicine 2009-03, Vol.35 (3), p.546-549 |
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| creator | Lavinio, A. Rasulo, F. A. De Peri, E. Czosnyka, M. Latronico, N. |
| description | Objective
The pressure–volume index (PVI) can be used to assess the cerebrospinal fluid dynamics and intracranial elastance in critically ill brain injured patients. The dependency of PVI on the state of cerebral autoregulation within the physiologic range of cerebral perfusion pressure (CPP) can be described by mathematical models that account for changes in cerebral blood volume during PVI testing. This relationship has never been verified clinically using direct PVI measurement and independent cerebral autoregulation assessment.
Design, setting, and patients
PVI and cerebral autoregulation were prospectively assessed in a cohort of 19 comatose patients admitted to an academic intensive care unit in Brescia, Italy.
Intervention
None.
Methods
PVI was measured injecting a fixed volume of 2 ml of 0.9% sodium chloride solution into the cerebral ventricles through an intraventricular catheter. Cerebral autoregulation was assessed using transcranial Doppler transient hyperaemic response (THR) test.
Measurements and results
Fifty-nine PVI assessments and 59 THR tests were performed. Mean PVI was 20.0 (SD 10.2) millilitres in sessions when autoregulation was intact (THR test ≥1.1) and 31.6 (8.8) millilitres in sessions with defective autoregulation (THR test |
| doi_str_mv | 10.1007/s00134-008-1311-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_66926902</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>66926902</sourcerecordid><originalsourceid>FETCH-LOGICAL-c430t-87dbe33f1ddead929b8df469dffd48124dece81240d751b06cd037359ccdd3a3</originalsourceid><addsrcrecordid>eNqF0c1q3DAQB3ARUrKbbR-gl2ICzc2NRpJl6xiWNC0s9LLXIGRpvOvFa28kOx-3vkPfsE8SGS8NBEJPOsxvRtL8CfkM9BtQml8FSoGLlNIiBQ6QZidkDoKzFBgvTsmccsFSIQWbkfMQdlHnMoMzMoOiyGJXPid36y0mHhvT110btvUhKbF_RGyTPhbqtvfGetPWpkkOHkMYPP79_eeha4b9WHb4lJjWJRY9lj4iM_Sdx80wDfxIPlSmCfjpeC7I-vvNevkjXf26_bm8XqVWcNqnRe5K5LwC59A4xVRZuEpI5arKiQKYcGhxPKnLMyiptI7ynGfKWue44QtyOY09-O5-wNDrfR0sNo1psRuCllIxqSj7L2Q0A8nUCC_ewF03-Db-QbMomMqBRgQTsr4LwWOlD77eG_-sgeoxID0FpOOq9RiQzmLPl-Pgodyje-04JhLB1yMwwZqmisu3dfjnGIBQHGR0bHIhltoN-tcXvn_7C8OOqn4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>216229710</pqid></control><display><type>article</type><title>The relationship between the intracranial pressure–volume index and cerebral autoregulation</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lavinio, A. ; Rasulo, F. A. ; De Peri, E. ; Czosnyka, M. ; Latronico, N.</creator><creatorcontrib>Lavinio, A. ; Rasulo, F. A. ; De Peri, E. ; Czosnyka, M. ; Latronico, N.</creatorcontrib><description>Objective
The pressure–volume index (PVI) can be used to assess the cerebrospinal fluid dynamics and intracranial elastance in critically ill brain injured patients. The dependency of PVI on the state of cerebral autoregulation within the physiologic range of cerebral perfusion pressure (CPP) can be described by mathematical models that account for changes in cerebral blood volume during PVI testing. This relationship has never been verified clinically using direct PVI measurement and independent cerebral autoregulation assessment.
Design, setting, and patients
PVI and cerebral autoregulation were prospectively assessed in a cohort of 19 comatose patients admitted to an academic intensive care unit in Brescia, Italy.
Intervention
None.
Methods
PVI was measured injecting a fixed volume of 2 ml of 0.9% sodium chloride solution into the cerebral ventricles through an intraventricular catheter. Cerebral autoregulation was assessed using transcranial Doppler transient hyperaemic response (THR) test.
Measurements and results
Fifty-nine PVI assessments and 59 THR tests were performed. Mean PVI was 20.0 (SD 10.2) millilitres in sessions when autoregulation was intact (THR test ≥1.1) and 31.6 (8.8) millilitres in sessions with defective autoregulation (THR test <1.1) (ΔPVI = 11.7 ml, 95% CI = 4.7–19.3 ml;
P
= 0.002). Intracranial pressure, CPP and brain CT findings were not significantly different between the measurements with intact and disturbed autoregulation.
Conclusions
Cerebral autoregulation status can affect PVI estimation despite a normal CPP. PVI measurement may overestimate the tolerance of the intracranial system to volume loads in patients with disturbed cerebral autoregulation.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-008-1311-5</identifier><identifier>PMID: 18850087</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Adolescent ; Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthesiology ; Biological and medical sciences ; Blood pressure ; Brain - blood supply ; Brain Injuries - complications ; Brain Injuries - epidemiology ; Brief Report ; Catheters ; Cerebrovascular Circulation - physiology ; Critical Care Medicine ; Emergency and intensive respiratory care ; Emergency Medicine ; Female ; Hemorrhage ; Homeostasis - physiology ; Humans ; Hyperemia - diagnosis ; Hyperemia - epidemiology ; Hyperemia - etiology ; Hypertension ; Intensive ; Intensive care ; Intensive care medicine ; Intracranial Hypertension - diagnosis ; Intracranial Hypertension - epidemiology ; Intracranial Hypertension - etiology ; Intracranial pressure ; Intracranial Pressure - physiology ; Male ; Mathematical models ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurosciences ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Severity of Illness Index ; Ultrasonography, Doppler, Transcranial ; Young Adult</subject><ispartof>Intensive care medicine, 2009-03, Vol.35 (3), p.546-549</ispartof><rights>Springer-Verlag 2008</rights><rights>2009 INIST-CNRS</rights><rights>Springer-Verlag 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c430t-87dbe33f1ddead929b8df469dffd48124dece81240d751b06cd037359ccdd3a3</citedby><cites>FETCH-LOGICAL-c430t-87dbe33f1ddead929b8df469dffd48124dece81240d751b06cd037359ccdd3a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-008-1311-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-008-1311-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21149316$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18850087$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lavinio, A.</creatorcontrib><creatorcontrib>Rasulo, F. A.</creatorcontrib><creatorcontrib>De Peri, E.</creatorcontrib><creatorcontrib>Czosnyka, M.</creatorcontrib><creatorcontrib>Latronico, N.</creatorcontrib><title>The relationship between the intracranial pressure–volume index and cerebral autoregulation</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Objective
The pressure–volume index (PVI) can be used to assess the cerebrospinal fluid dynamics and intracranial elastance in critically ill brain injured patients. The dependency of PVI on the state of cerebral autoregulation within the physiologic range of cerebral perfusion pressure (CPP) can be described by mathematical models that account for changes in cerebral blood volume during PVI testing. This relationship has never been verified clinically using direct PVI measurement and independent cerebral autoregulation assessment.
Design, setting, and patients
PVI and cerebral autoregulation were prospectively assessed in a cohort of 19 comatose patients admitted to an academic intensive care unit in Brescia, Italy.
Intervention
None.
Methods
PVI was measured injecting a fixed volume of 2 ml of 0.9% sodium chloride solution into the cerebral ventricles through an intraventricular catheter. Cerebral autoregulation was assessed using transcranial Doppler transient hyperaemic response (THR) test.
Measurements and results
Fifty-nine PVI assessments and 59 THR tests were performed. Mean PVI was 20.0 (SD 10.2) millilitres in sessions when autoregulation was intact (THR test ≥1.1) and 31.6 (8.8) millilitres in sessions with defective autoregulation (THR test <1.1) (ΔPVI = 11.7 ml, 95% CI = 4.7–19.3 ml;
P
= 0.002). Intracranial pressure, CPP and brain CT findings were not significantly different between the measurements with intact and disturbed autoregulation.
Conclusions
Cerebral autoregulation status can affect PVI estimation despite a normal CPP. PVI measurement may overestimate the tolerance of the intracranial system to volume loads in patients with disturbed cerebral autoregulation.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthesiology</subject><subject>Biological and medical sciences</subject><subject>Blood pressure</subject><subject>Brain - blood supply</subject><subject>Brain Injuries - complications</subject><subject>Brain Injuries - epidemiology</subject><subject>Brief Report</subject><subject>Catheters</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Critical Care Medicine</subject><subject>Emergency and intensive respiratory care</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Hemorrhage</subject><subject>Homeostasis - physiology</subject><subject>Humans</subject><subject>Hyperemia - diagnosis</subject><subject>Hyperemia - epidemiology</subject><subject>Hyperemia - etiology</subject><subject>Hypertension</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Intracranial Hypertension - diagnosis</subject><subject>Intracranial Hypertension - epidemiology</subject><subject>Intracranial Hypertension - etiology</subject><subject>Intracranial pressure</subject><subject>Intracranial Pressure - physiology</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurosciences</subject><subject>Pain Medicine</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Severity of Illness Index</subject><subject>Ultrasonography, Doppler, Transcranial</subject><subject>Young Adult</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqF0c1q3DAQB3ARUrKbbR-gl2ICzc2NRpJl6xiWNC0s9LLXIGRpvOvFa28kOx-3vkPfsE8SGS8NBEJPOsxvRtL8CfkM9BtQml8FSoGLlNIiBQ6QZidkDoKzFBgvTsmccsFSIQWbkfMQdlHnMoMzMoOiyGJXPid36y0mHhvT110btvUhKbF_RGyTPhbqtvfGetPWpkkOHkMYPP79_eeha4b9WHb4lJjWJRY9lj4iM_Sdx80wDfxIPlSmCfjpeC7I-vvNevkjXf26_bm8XqVWcNqnRe5K5LwC59A4xVRZuEpI5arKiQKYcGhxPKnLMyiptI7ynGfKWue44QtyOY09-O5-wNDrfR0sNo1psRuCllIxqSj7L2Q0A8nUCC_ewF03-Db-QbMomMqBRgQTsr4LwWOlD77eG_-sgeoxID0FpOOq9RiQzmLPl-Pgodyje-04JhLB1yMwwZqmisu3dfjnGIBQHGR0bHIhltoN-tcXvn_7C8OOqn4</recordid><startdate>20090301</startdate><enddate>20090301</enddate><creator>Lavinio, A.</creator><creator>Rasulo, F. A.</creator><creator>De Peri, E.</creator><creator>Czosnyka, M.</creator><creator>Latronico, N.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7TK</scope><scope>7X8</scope></search><sort><creationdate>20090301</creationdate><title>The relationship between the intracranial pressure–volume index and cerebral autoregulation</title><author>Lavinio, A. ; Rasulo, F. A. ; De Peri, E. ; Czosnyka, M. ; Latronico, N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c430t-87dbe33f1ddead929b8df469dffd48124dece81240d751b06cd037359ccdd3a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthesiology</topic><topic>Biological and medical sciences</topic><topic>Blood pressure</topic><topic>Brain - blood supply</topic><topic>Brain Injuries - complications</topic><topic>Brain Injuries - epidemiology</topic><topic>Brief Report</topic><topic>Catheters</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Critical Care Medicine</topic><topic>Emergency and intensive respiratory care</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Hemorrhage</topic><topic>Homeostasis - physiology</topic><topic>Humans</topic><topic>Hyperemia - diagnosis</topic><topic>Hyperemia - epidemiology</topic><topic>Hyperemia - etiology</topic><topic>Hypertension</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Intracranial Hypertension - diagnosis</topic><topic>Intracranial Hypertension - epidemiology</topic><topic>Intracranial Hypertension - etiology</topic><topic>Intracranial pressure</topic><topic>Intracranial Pressure - physiology</topic><topic>Male</topic><topic>Mathematical models</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurosciences</topic><topic>Pain Medicine</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Severity of Illness Index</topic><topic>Ultrasonography, Doppler, Transcranial</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lavinio, A.</creatorcontrib><creatorcontrib>Rasulo, F. A.</creatorcontrib><creatorcontrib>De Peri, E.</creatorcontrib><creatorcontrib>Czosnyka, M.</creatorcontrib><creatorcontrib>Latronico, N.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lavinio, A.</au><au>Rasulo, F. A.</au><au>De Peri, E.</au><au>Czosnyka, M.</au><au>Latronico, N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The relationship between the intracranial pressure–volume index and cerebral autoregulation</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2009-03-01</date><risdate>2009</risdate><volume>35</volume><issue>3</issue><spage>546</spage><epage>549</epage><pages>546-549</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>Objective
The pressure–volume index (PVI) can be used to assess the cerebrospinal fluid dynamics and intracranial elastance in critically ill brain injured patients. The dependency of PVI on the state of cerebral autoregulation within the physiologic range of cerebral perfusion pressure (CPP) can be described by mathematical models that account for changes in cerebral blood volume during PVI testing. This relationship has never been verified clinically using direct PVI measurement and independent cerebral autoregulation assessment.
Design, setting, and patients
PVI and cerebral autoregulation were prospectively assessed in a cohort of 19 comatose patients admitted to an academic intensive care unit in Brescia, Italy.
Intervention
None.
Methods
PVI was measured injecting a fixed volume of 2 ml of 0.9% sodium chloride solution into the cerebral ventricles through an intraventricular catheter. Cerebral autoregulation was assessed using transcranial Doppler transient hyperaemic response (THR) test.
Measurements and results
Fifty-nine PVI assessments and 59 THR tests were performed. Mean PVI was 20.0 (SD 10.2) millilitres in sessions when autoregulation was intact (THR test ≥1.1) and 31.6 (8.8) millilitres in sessions with defective autoregulation (THR test <1.1) (ΔPVI = 11.7 ml, 95% CI = 4.7–19.3 ml;
P
= 0.002). Intracranial pressure, CPP and brain CT findings were not significantly different between the measurements with intact and disturbed autoregulation.
Conclusions
Cerebral autoregulation status can affect PVI estimation despite a normal CPP. PVI measurement may overestimate the tolerance of the intracranial system to volume loads in patients with disturbed cerebral autoregulation.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>18850087</pmid><doi>10.1007/s00134-008-1311-5</doi><tpages>4</tpages></addata></record> |
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| ispartof | Intensive care medicine, 2009-03, Vol.35 (3), p.546-549 |
| issn | 0342-4642 1432-1238 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adolescent Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthesiology Biological and medical sciences Blood pressure Brain - blood supply Brain Injuries - complications Brain Injuries - epidemiology Brief Report Catheters Cerebrovascular Circulation - physiology Critical Care Medicine Emergency and intensive respiratory care Emergency Medicine Female Hemorrhage Homeostasis - physiology Humans Hyperemia - diagnosis Hyperemia - epidemiology Hyperemia - etiology Hypertension Intensive Intensive care Intensive care medicine Intracranial Hypertension - diagnosis Intracranial Hypertension - epidemiology Intracranial Hypertension - etiology Intracranial pressure Intracranial Pressure - physiology Male Mathematical models Medical sciences Medicine Medicine & Public Health Middle Aged Neurosciences Pain Medicine Patients Pediatrics Pneumology/Respiratory System Severity of Illness Index Ultrasonography, Doppler, Transcranial Young Adult |
| title | The relationship between the intracranial pressure–volume index and cerebral autoregulation |
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