SIGNIFICANCE OF INTRACRANIAL-PRESSURE WAVE-FORM ANALYSIS AFTER HEAD-INJURY

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 continu ously 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 a mplitude of ICP pulse waveform was assessed using the fundamental harm onic of the pulse waveform (AMP) to avoid distortion caused by differe nt 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 a nd then began to decrease. The upper breakpoint of the AMP-ICP relatio nship was not present in patients with good/moderate outcome. The movi ng correlation coefficient between the fundamental harmonic of ICP pul se wave and the mean ICP (RAP: R-symbol of correlation between A-ampli tude and P-pressure) was introduced to describe the time-dependent cha nges in correlation between amplitude and mean ICP. The RAP was signif icantly 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 p eriod longer than 6 hours with low correlation between the amplitude a nd pressure (RAP < 0.5) was described as an predictive index of an unf avourable outcome.